Provider Demographics
NPI:1790137685
Name:SHAH FOOT & ANKLE LLC
Entity Type:Organization
Organization Name:SHAH FOOT & ANKLE LLC
Other - Org Name:SEEBER FOOT & ANKLE LTD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER / CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:BIREN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:847-254-5939
Mailing Address - Street 1:3851 N MULFORD RD
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61114-5603
Mailing Address - Country:US
Mailing Address - Phone:847-254-5939
Mailing Address - Fax:
Practice Address - Street 1:3851 N MULFORD RD
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61114-5603
Practice Address - Country:US
Practice Address - Phone:847-254-5939
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-05
Last Update Date:2016-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016.005692213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty