Healthcare Provider Details

I. General information

NPI: 1215850334
Provider Name (Legal Business Name): HARSH NIMESH SHAH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 N 4TH ST
SPRINGFIELD IL
62702-5208
US

IV. Provider business mailing address

520 N 4TH ST
SPRINGFIELD IL
62702-5208
US

V. Phone/Fax

Practice location:
  • Phone: 217-757-8197
  • Fax:
Mailing address:
  • Phone: 217-545-8000
  • Fax: 217-757-8161

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number125088145
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: