Provider Demographics
NPI:1588631378
Name:SHAH, ASAD (MD)
Entity Type:Individual
Prefix:
First Name:ASAD
Middle Name:
Last Name:SHAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2560 HAUSER ROSS DR STE 450
Mailing Address - Street 2:
Mailing Address - City:SYCAMORE
Mailing Address - State:IL
Mailing Address - Zip Code:60178-3185
Mailing Address - Country:US
Mailing Address - Phone:815-748-3040
Mailing Address - Fax:815-748-3070
Practice Address - Street 1:2560 HAUSER ROSS DR
Practice Address - Street 2:SUITE 450
Practice Address - City:SYCAMORE
Practice Address - State:IL
Practice Address - Zip Code:60178-3150
Practice Address - Country:US
Practice Address - Phone:815-748-0340
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-01
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036103130207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036103130Medicaid
ILP00202079Medicare PIN
ILIL2556005Medicare PIN
ILP00788849Medicare PIN
ILK29502Medicare PIN
ILH53802Medicare UPIN
ILF400099318Medicare PIN
ILIL2797001Medicare PIN
ILK14958Medicare PIN