Provider Demographics
NPI:1609821008
Name:SHAH MEDICAL ASSOCIATES LLC
Entity Type:Organization
Organization Name:SHAH MEDICAL ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ASAD
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-964-8199
Mailing Address - Street 1:2560 HAUSER ROSS DR
Mailing Address - Street 2:SUITE 450
Mailing Address - City:SYCAMORE
Mailing Address - State:IL
Mailing Address - Zip Code:60178-3150
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
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:703-964-8199
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0001932052OtherBCBS
IL213921Medicare PIN
ILDC9860Medicare PIN
IL211056Medicare PIN