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General NPI Number Information
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NPI Number | 1902149982
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Entity Type | Individual
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Provider Name | MAULIN G SHAH D.O.
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Gender | Male
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Dates
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Enumeration Date | 03/28/2013
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Last Update Date | 02/25/2019
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Provider Practice Location Address
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Address Line | 107 WATTERS DR
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City | DWIGHT
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State | IL
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Zip | 60420
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Country | US
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Telephone | 815-584-4334
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Fax | 815-584-4364
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Provider Business Mailing Address
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Address Line | 107 WATTERS DR
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City | DWIGHT
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State | IL
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Zip | 60420-1280
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Country | US
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Telephone | 815-584-4334
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Fax | 815-584-4364
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 036141076
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License Number State | IL
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