Healthcare Provider Details

I. General information

NPI: 1093821704
Provider Name (Legal Business Name): BHARATI B. SHAH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

496 LEE ST
DES PLAINES IL
60016-4607
US

IV. Provider business mailing address

3502 MAPLE LEAF DR
GLENVIEW IL
60026-1131
US

V. Phone/Fax

Practice location:
  • Phone: 847-824-2161
  • Fax: 824-824-1042
Mailing address:
  • Phone: 847-824-2161
  • Fax: 847-824-1042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: