=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760225650
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KARINA ATUL SHAH
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/17/2024
-----------------------------------------------------
Last Update Date | 09/09/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 800 BIESTERFIELD RD STE 705B
-----------------------------------------------------
City | ELK GROVE VLG
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60007-3361
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-981-3623
-----------------------------------------------------
Fax | 847-981-3502
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 800 BIESTERFIELD RD STE 705B
-----------------------------------------------------
City | ELK GROVE VLG
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60007-3361
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-981-3623
-----------------------------------------------------
Fax | 847-981-3502
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | 085010860
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------