Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 249068 | NY |
N | 207Q00000X | Family Doctor | MD60257660 | WA |
Y | 207QA0401X | Family Doctor - Addiction Medicine | 036136479 | IL |
NPI | 1700047016 |
---|---|
Provider Name | Avani Sheth |
First Address | Chicago, IL 60622-1797 |
Second Address | Chicago, IL 60622-1797 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/06/2008 |
Last Update Date | 25/08/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036136479 | (05) | IL |
8908875 | (02) |