Healthcare Provider Details

I. General information

NPI: 1689674970
Provider Name (Legal Business Name): DHRULATA R SHAH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 CENTER ST SUITE 203
ELGIN IL
60120-2104
US

IV. Provider business mailing address

10821 CORTLAND LN
HUNTLEY IL
60142-4076
US

V. Phone/Fax

Practice location:
  • Phone: 847-890-8562
  • Fax: 847-429-2348
Mailing address:
  • Phone: 847-961-6550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: