Provider Demographics
NPI:1699959213
Name:SHAH, UNA (MD)
Entity type:Individual
Prefix:
First Name:UNA
Middle Name:
Last Name:SHAH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:905 FOX GLEN CT
Mailing Address - Street 2:
Mailing Address - City:BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010-1863
Mailing Address - Country:US
Mailing Address - Phone:847-277-1200
Mailing Address - Fax:847-277-1209
Practice Address - Street 1:905 FOX GLEN CT
Practice Address - Street 2:
Practice Address - City:BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-1863
Practice Address - Country:US
Practice Address - Phone:847-277-1200
Practice Address - Fax:847-277-1209
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-18
Last Update Date:2011-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-102086174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL206387Medicare PIN