Provider Demographics
NPI:1750515300
Name:NORTHWEST SUBURBAN PHYSICIANS LLC
Entity type:Organization
Organization Name:NORTHWEST SUBURBAN PHYSICIANS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GHANSHYAM
Authorized Official - Middle Name:S
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-255-7107
Mailing Address - Street 1:5999 NEW WILKE RD BLDG 2
Mailing Address - Street 2:
Mailing Address - City:ROLLING MEADOWS
Mailing Address - State:IL
Mailing Address - Zip Code:60008-4506
Mailing Address - Country:US
Mailing Address - Phone:847-255-7107
Mailing Address - Fax:847-255-7031
Practice Address - Street 1:5999 NEW WILKE RD BLDG 2
Practice Address - Street 2:SUITE 200
Practice Address - City:ROLLING MEADOWS
Practice Address - State:IL
Practice Address - Zip Code:60008-4506
Practice Address - Country:US
Practice Address - Phone:847-255-7107
Practice Address - Fax:847-255-7031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-12
Last Update Date:2015-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty