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General NPI Number Information
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NPI Number | 1295186872
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Entity Type | Individual
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Provider Name | RAVI SHAH M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/25/2016
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Last Update Date | 01/28/2025
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Provider Practice Location Address
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Address Line | 2640 183RD ST
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City | HOMEWOOD
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State | IL
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Zip | 60430-2914
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Country | US
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Telephone | 708-798-6633
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Fax | 708-798-6790
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Provider Business Mailing Address
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Address Line | 2855 GRAMERCY ST STE 400
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City | HOUSTON
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State | TX
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Zip | 77025-1697
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Country | US
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Telephone | 713-668-6828
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Fax | 713-668-3823
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 036172784
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | S6038
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License Number State | TX
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