Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0003X | Hematology & Oncology | 036110949 | IL |
NPI | 1043242860 |
---|---|
Provider Name | Dr. Mousami Shah |
First Address | Oak Brook, IL 60523-2349 |
Second Address | Oak Lawn, IL 60453-2600 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2006 |
Last Update Date | 15/12/2021 |