Provider Demographics
NPI:1255586665
Name:SHAH, KALPESH M
Entity type:Individual
Prefix:MR
First Name:KALPESH
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 1:401 E 61ST ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60637-2324
Mailing Address - Country:US
Mailing Address - Phone:773-667-4400
Mailing Address - Fax:773-667-5040
Practice Address - Street 1:401 E 61ST ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60637-2324
Practice Address - Country:US
Practice Address - Phone:773-667-4400
Practice Address - Fax:773-667-5040
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-26
Last Update Date:2009-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051031784183500000X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
4567130001Medicare NSC