| Shah Alam Pc | |
|
2701 W 68th St Holy Cross Hospital Chicago IL 60629-1813 | |
| (773) 884-9000 | |
| Not Available |
| Full Name | Shah Alam Pc |
|---|---|
| Speciality | Internal Medicine |
| Location | 2701 W 68th St, Chicago, Illinois |
| Authorized Official Name and Position | Shah A Alam (PRESIDENT) |
| Authorized Official Contact | 6303067944 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Shah Alam Pc 1057 Cherry Ln Lombard IL 60148-4033 Ph: (630) 306-7944 | Shah Alam Pc 2701 W 68th St Holy Cross Hospital Chicago IL 60629-1813 Ph: (773) 884-9000 |
| NPI Number | 1457698748 |
|---|---|
| Provider Enumeration Date | 01/07/2013 |
| Last Update Date | 01/08/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457698748 | NPI | - | NPPES |
| 036114268 | Medicaid | IL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 036114268 (Illinois) | Secondary |
| 207R00000X | Internal Medicine | 036114268 (Illinois) | Primary |
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