Shah, Prabodh C

Shah, Prabodh C is an individual health care provider with primary practice located at 2800 W 95Th St Cancer Center, Evergreen Park IL 60805-2701. He recently has only one registered license in Allopathic & Osteopathic Physicians / Hematology & Oncology, which is considered as his primary health care specialty. Shah, Prabodh C can be contacted via phone (708) 229-6020.

Contact Information

Primary practice address
2800 W 95Th St Cancer Center Evergreen Park IL 60805-2701
Phone: (708) 229-6020
Fax: (708) 229-6083
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Hematology & Oncology 207RH0003X 036042091 Illinois
Allopathic & Osteopathic Physicians / Hematology & Oncology 207RH0003X A25747 California

Profile Details

NPI number 1316935240
LBN Legal business name Shah, Prabodh C
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 13th, 2005
Last updated Jun 23rd, 2014 - about 10 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1316935240 NPPES
Illinois Other 036042091 LICENSE
Illinois MEDICAID 036042091 LICENSE
Illinois Other M050376 LICENSE
Illinois MEDICAID 00A257470 LICENSE

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