Provider Demographics
NPI:1962798801
Name:GOBIN, KARINA SHAH (MD)
Entity type:Individual
Prefix:DR
First Name:KARINA
Middle Name:SHAH
Last Name:GOBIN
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 1:675 W NORTH AVE STE 310
Mailing Address - Street 2:
Mailing Address - City:MELROSE PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60160-1606
Mailing Address - Country:US
Mailing Address - Phone:708-450-5054
Mailing Address - Fax:705-450-5054
Practice Address - Street 1:675 W NORTH AVE STE 310
Practice Address - Street 2:
Practice Address - City:MELROSE PARK
Practice Address - State:IL
Practice Address - Zip Code:60160-1606
Practice Address - Country:US
Practice Address - Phone:708-450-5054
Practice Address - Fax:708-450-9088
Is Sole Proprietor?:No
Enumeration Date:2011-06-20
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI64046208000000X, 207K00000X
IL125-060259208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1962798801Medicaid
IL1962798801Medicaid