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General NPI Number Information
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NPI Number | 1902255656
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Entity Type | Individual
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Provider Name | NISHITH SHAH M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/03/2016
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Last Update Date | 09/13/2024
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Provider Practice Location Address
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Address Line | 3401 N PERRYVILLE RD
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City | ROCKFORD
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State | IL
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Zip | 61114-8011
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Country | US
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Telephone | 815-971-3610
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Fax |
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Provider Business Mailing Address
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Address Line | 820 RTE 59 STE A
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City | BARTLETT
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State | IL
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Zip | 60103-1300
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Country | US
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Telephone | 630-483-5930
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Fax | 630-483-5939
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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 | 036.150303
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License Number State | IL
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