Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | 036-122199 | IL |
N | 207R00000X | Internist | 125-051094 | IL |
N | 111NI0900X | Internist | 125-051094 | IL |
NPI | 1053592451 |
---|---|
Provider Name | Dr. Rachna Shah |
First Address | Melrose Park, IL 60160-1634 |
Second Address | Melrose Park, IL 60160-1634 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/11/2007 |
Last Update Date | 20/01/2012 |