Provider Demographics
NPI:1790060044
Name:SHAH, MILAN M
Entity Type:Individual
Prefix:
First Name:MILAN
Middle Name:M
Last Name:SHAH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 W RANDOLPH ST STE 101
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60601-3377
Mailing Address - Country:US
Mailing Address - Phone:312-525-3984
Mailing Address - Fax:312-525-3987
Practice Address - Street 1:100 W RANDOLPH ST STE 101
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601-3377
Practice Address - Country:US
Practice Address - Phone:312-525-3984
Practice Address - Fax:312-525-3987
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-19
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.288050183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist