Provider Demographics
NPI:1013925395
Name:SHAH, DEVINA A (MD)
Entity Type:Individual
Prefix:
First Name:DEVINA
Middle Name:A
Last Name:SHAH
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 1:11240 S MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60628-4941
Mailing Address - Country:US
Mailing Address - Phone:773-468-9000
Mailing Address - Fax:773-995-9181
Practice Address - Street 1:11240 S MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60628-4941
Practice Address - Country:US
Practice Address - Phone:773-468-9000
Practice Address - Fax:773-995-9181
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2011-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036059687207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL31603534OtherBLUE CROSS/SHIELD
IL036059687Medicaid
IL050013082OtherRAIL ROAD MEDICARE
IL050013082OtherRAIL ROAD MEDICARE
ILC43294Medicare UPIN