Healthcare Provider Details

I. General information

NPI: 1417096553
Provider Name (Legal Business Name): VIPIN A SHAH ARRT, ARMRIT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 11/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

821 E. SCHAUMBURG RD.
SCHAUMBURG IL
60194
US

IV. Provider business mailing address

1035 BOURNE LN
SCHAUMBURG IL
60193-2653
US

V. Phone/Fax

Practice location:
  • Phone: 630-400-8096
  • Fax:
Mailing address:
  • Phone: 630-400-8096
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471C3402X
TaxonomyRadiography Radiologic Technologist
License Number305743
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: