Provider Demographics
NPI:1609815414
Name:SHAH, SHEFALI K (MD)
Entity type:Individual
Prefix:DR
First Name:SHEFALI
Middle Name:K
Last Name:SHAH
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29373 NETWORK PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60673-1293
Mailing Address - Country:US
Mailing Address - Phone:847-390-5900
Mailing Address - Fax:847-390-4757
Practice Address - Street 1:2623 N HALSTED ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-2393
Practice Address - Country:US
Practice Address - Phone:773-929-7410
Practice Address - Fax:773-929-7403
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036111947207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036111947Medicaid
110008973OtherRAILROAD MEDICARE
IL31600190OtherBCBS OF IL
IL036111947Medicaid
110008973OtherRAILROAD MEDICARE