Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RN0300X | Nephrologist | 036108396 | IL |
NPI | 1073643193 |
---|---|
Provider Name | Mrs. Malathi Shah |
First Address | Oak Brook, IL 60523-1563 |
Second Address | Chicago, IL 60649-3603 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/03/2007 |
Last Update Date | 15/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H41133 | (02) | IL |