Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 036-075746 | IL |
N | 111NI0900X | Internist | 036-075746 | IL |
Y | 207RI0200X | Infectious Disease | 036075746 | IL |
NPI | 1093776460 |
---|---|
Provider Name | Dr. Beverly E Sha |
First Address | Chicago, IL 60612-3806 |
Second Address | Chicago, IL 60612-3806 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2006 |
Last Update Date | 30/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036075746 | (05) | IL |
440003645 | RR MEDICARE (01) | IL |
E18918 | (02) | IL |