Healthcare Provider Details

I. General information

NPI: 1255591632
Provider Name (Legal Business Name): SHIVANI PANKAJ SHAH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2008
Last Update Date: 02/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 SALT CREEK LN SUITE 106
HINSDALE IL
60521-8605
US

IV. Provider business mailing address

12 SALT CREEK LN SUITE 106
HINSDALE IL
60521-8605
US

V. Phone/Fax

Practice location:
  • Phone: 630-856-2731
  • Fax: 630-323-0260
Mailing address:
  • Phone: 630-856-2731
  • Fax: 630-323-0260

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code282NC2000X
TaxonomyChildren's Hospital
License Number036.120677
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License Number036120677
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: