Healthcare Provider Details

I. General information

NPI: 1982289757
Provider Name (Legal Business Name): AROOJ FATIMAH SHAH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2021
Last Update Date: 08/29/2024
Certification Date: 08/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 N RUTLEDGE ST
SPRINGFIELD IL
62702-4933
US

IV. Provider business mailing address

8900 VAN WYCK EXPY
RICHMOND HILL NY
11418-2832
US

V. Phone/Fax

Practice location:
  • Phone: 217-545-8000
  • Fax:
Mailing address:
  • Phone: 571-447-1955
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number125.083740
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: