Healthcare Provider Details

I. General information

NPI: 1295266450
Provider Name (Legal Business Name): DEEP SHAH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2017
Last Update Date: 04/24/2025
Certification Date: 04/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 MARTIN AVE STE 200
NAPERVILLE IL
60540-6535
US

IV. Provider business mailing address

10 MARTIN AVE STE 200
NAPERVILLE IL
60540-6535
US

V. Phone/Fax

Practice location:
  • Phone: 630-600-0700
  • Fax: 630-600-0701
Mailing address:
  • Phone: 630-600-0700
  • Fax: 630-600-0701

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 StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35.135377
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number036.170394
License Number StateIL
# 4
Primary TaxonomyY
Taxonomy Code207RA0001X
TaxonomyAdvanced Heart Failure and Transplant Cardiology Physician
License Number036.170394
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: