Healthcare Provider Details

I. General information

NPI: 1275110249
Provider Name (Legal Business Name): NIKI SAMIR SHAH DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2021
Last Update Date: 06/30/2025
Certification Date: 06/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 OGDEN AVE
AURORA IL
60504-5893
US

IV. Provider business mailing address

2000 OGDEN AVE
AURORA IL
60504-5893
US

V. Phone/Fax

Practice location:
  • Phone: 866-565-8607
  • Fax: 312-563-8661
Mailing address:
  • Phone: 866-565-8607
  • Fax: 312-563-8661

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036169311
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number036.169311
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: