Provider Demographics
NPI:1942680319
Name:SHAH, ARCHANA ANIL (MD)
Entity Type:Individual
Prefix:DR
First Name:ARCHANA
Middle Name:ANIL
Last Name:SHAH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:5841 S MARYLAND AVE
Mailing Address - Street 2:MC 5068, ROOM L539
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60637-1447
Mailing Address - Country:US
Mailing Address - Phone:773-702-9500
Mailing Address - Fax:773-702-3135
Practice Address - Street 1:5841 S MARYLAND AVE
Practice Address - Street 2:MC 5068, ROOM L539
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60637
Practice Address - Country:US
Practice Address - Phone:773-702-9500
Practice Address - Fax:773-702-3135
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-01
Last Update Date:2018-07-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036-146643207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine