Provider Demographics
NPI:1972598233
Name:NAIR, SHANTA (MD)
Entity Type:Individual
Prefix:DR
First Name:SHANTA
Middle Name:
Last Name:NAIR
Suffix:
Gender:F
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:METROPOLITAN FAMILY SERVICES
Mailing Address - Street 2:1 NORTH DEARBORN STREET
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60602-4322
Mailing Address - Country:US
Mailing Address - Phone:312-986-4454
Mailing Address - Fax:312-986-4454
Practice Address - Street 1:10537 S ROBERTS RD
Practice Address - Street 2:
Practice Address - City:PALOS HILLS
Practice Address - State:IL
Practice Address - Zip Code:60465-1933
Practice Address - Country:US
Practice Address - Phone:708-974-2300
Practice Address - Fax:708-974-2498
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2018-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
IL0360699562084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILC45236Medicare UPIN