Healthcare Provider Details

I. General information

NPI: 1689251274
Provider Name (Legal Business Name): MEHUL SHAH DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2021
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2040 OGDEN AVE STE 401
AURORA IL
60504-7208
US

IV. Provider business mailing address

2040 OGDEN AVE STE 401
AURORA IL
60504-7208
US

V. Phone/Fax

Practice location:
  • Phone: 630-978-4889
  • Fax:
Mailing address:
  • Phone: 630-978-4889
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number036.167863
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number125.078585
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: