K S Shah MD SC

Primary specialty

Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X

License

36-048096 Issued in IL

Legal business name

K S SHAH MD SC

Practice address

17680 Kedzie Ave
Ste 201
Hazel Crest, IL 60429-2043

Phone

(708) 799-5420

Fax

(708) 799-4093

NPI assigned

Mar 27, 2012

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Donna M Peterson

Title

Office Manager

Phone

(708) 799-5420

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1332806400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1332806400000",
    "number": "1487920252",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17680 KEDZIE AVE",
            "address_2": "STE 201",
            "city": "HAZEL CREST",
            "state": "IL",
            "postal_code": "604292043",
            "telephone_number": "708-799-5420",
            "fax_number": "708-799-4093"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17680 KEDZIE AVE",
            "address_2": "STE 201",
            "city": "HAZEL CREST",
            "state": "IL",
            "postal_code": "604292043",
            "telephone_number": "708-799-5420",
            "fax_number": "708-799-4093"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "K S SHAH MD SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-03-27",
        "last_updated": "2012-03-27",
        "status": "A",
        "authorized_official_last_name": "PETERSON",
        "authorized_official_first_name": "DONNA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "708-799-5420",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": "IL",
            "license": "36-048096",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Obstetrics & Gynecology Physician in Hazel Crest, IL
• Providers in Hazel Crest, IL by specialty
• Obstetrics & Gynecology Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.