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General NPI Number Information
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NPI Number | 1306078910
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Entity Type | Individual
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Provider Name | BHAVIN CHANDRAKANT SHAH MD
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Gender | Male
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Dates
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Enumeration Date | 08/14/2009
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Last Update Date | 06/26/2017
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Provider Practice Location Address
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Address Line | 301 MADISON ST STE 302
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City | JOLIET
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State | IL
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Zip | 60435-6995
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Country | US
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Telephone | 815-582-3177
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Fax | 815-582-3754
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Provider Business Mailing Address
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Address Line | 1435 KALLIEN AVE.
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City | NAPERVILLE
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State | IL
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Zip | 60540
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Country | US
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Telephone | 815-582-3177
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Fax | 815-582-3754
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 036.138823
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 2086X0206X
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Taxonomy Name | Surgical Oncology Physician
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License Number | 036.138823
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License Number State | IL
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