Healthcare Provider Details

I. General information

NPI: 1891736492
Provider Name (Legal Business Name): VIJAY J SHAH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 07/21/2020
Certification Date: 07/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1320 N HIGHLAND AVE SUITE A
AURORA IL
60506-1403
US

IV. Provider business mailing address

1320 N HIGHLAND AVE STE B
AURORA IL
60506-1469
US

V. Phone/Fax

Practice location:
  • Phone: 630-896-0659
  • Fax: 630-896-0581
Mailing address:
  • Phone: 630-892-4286
  • Fax: 630-892-2104

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number036074019
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number036074019
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: