Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | 036139438 | IL |
NPI | 1093074916 |
---|---|
Provider Name | Dr. Neil B Shah |
First Address | Olympia Fields, IL 60461-1010 |
Second Address | Olympia Fields, IL 60461-1010 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/05/2012 |
Last Update Date | 22/01/2016 |