Provider Demographics
NPI:1356388524
Name:SHAH, DILIP (MD)
Entity type:Individual
Prefix:DR
First Name:DILIP
Middle Name:
Last Name:SHAH
Suffix:
Gender:M
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:PO BOX 470
Mailing Address - Street 2:6134 S HARLEM AVE
Mailing Address - City:SUMMIT
Mailing Address - State:IL
Mailing Address - Zip Code:60501-0470
Mailing Address - Country:US
Mailing Address - Phone:708-458-0102
Mailing Address - Fax:
Practice Address - Street 1:6134 S HARLEM AVE
Practice Address - Street 2:
Practice Address - City:SUMMIT
Practice Address - State:IL
Practice Address - Zip Code:60501-1625
Practice Address - Country:US
Practice Address - Phone:708-458-0102
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-31
Last Update Date:2016-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL336.021940174400000X
IL036.067272174400000X
IL036057272207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036057272Medicaid
IL31600233OtherBLUE CROSS BLUE SHIELD
IL111910586COtherRAILROAD MEDICARE
IL661071Medicare ID - Type Unspecified
ILD14500Medicare UPIN