Healthcare Provider Details

I. General information

NPI: 1942700588
Provider Name (Legal Business Name): SHIKHAR H SHAH MD, MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2018
Last Update Date: 06/19/2024
Certification Date: 06/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9040 JACKSON AVE
TACOMA WA
98431-4504
US

IV. Provider business mailing address

664 TACOMA DR
CAROL STREAM IL
60188-4744
US

V. Phone/Fax

Practice location:
  • Phone: 253-968-2543
  • Fax:
Mailing address:
  • Phone: 630-550-9303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number72511-20
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number72511-20
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: