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NPI Code Detail

MEDICARE: DR. KALPANA TUSHAR SHAH D.M.D.

MEDICARE: DR. KALPANA TUSHAR SHAH D.M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice Dentistry19025713IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1407846298
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KALPANA TUSHAR SHAH D.M.D.
Provider Business Mailing Address
First Line : 1 MICHELE CT
Second Line :
City : BOLINGBROOK
State : IL
Zip : 60490-4921
Country : US
Telephone Number : 815-609-7209
Fax Number :
Provider Business Practice Location Address
First Line : 2025 S CHICAGO ST
Second Line :
City : JOLIET
State : IL
Zip : 60436-3172
Country : US
Telephone Number : 815-727-5813
Fax Number : 815-727-7260
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/24/2005
Last Update Date : 12/02/2013

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