Smita J Shah, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

SMITA J SHAH, MD

Practice address

6905 Cermak Rd Ste a
Berwyn, IL 60402-2175

Phone

(708) 749-0091

NPI assigned

May 21, 2007

Organization subpart

No

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

Authorized official

Name

Diana Polyakov

Title

Billing Manager

Phone

(847) 897-5995

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1179705600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1740499573",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5979",
            "city": "BUFFALO GROVE",
            "state": "IL",
            "postal_code": "600895979",
            "telephone_number": "847-897-5995",
            "fax_number": "847-897-5990"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6905 CERMAK RD STE A",
            "city": "BERWYN",
            "state": "IL",
            "postal_code": "604022175",
            "telephone_number": "708-749-0091"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SMITA J SHAH, MD",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-21",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "POLYAKOV",
        "authorized_official_first_name": "DIANA",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "847-897-5995"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Internal Medicine Physician in Berwyn, IL
• Providers in Berwyn, IL by specialty
• Internal Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.