Provider Demographics
NPI:1144407594
Name:SHAH, SONIA (MD)
Entity type:Individual
Prefix:DR
First Name:SONIA
Middle Name:
Last Name:SHAH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SONIA
Other - Middle Name:
Other - Last Name:SHAH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1717 S PRAIRIE AVE APT 906
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616-4342
Mailing Address - Country:US
Mailing Address - Phone:773-936-9599
Mailing Address - Fax:
Practice Address - Street 1:4211 N CICERO AVE STE 203
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60641-1650
Practice Address - Country:US
Practice Address - Phone:773-794-8800
Practice Address - Fax:773-794-8830
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-29
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036121040207RA0201X
IL125050036207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & ImmunologyGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine