=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972730893
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MIHIR B SHAH D.O.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/18/2009
-----------------------------------------------------
Last Update Date | 10/01/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1221 N HIGHLAND AVE
-----------------------------------------------------
City | AURORA
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60506-1404
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-907-3969
-----------------------------------------------------
Fax | 630-907-3998
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1221 N HIGHLAND AVE
-----------------------------------------------------
City | AURORA
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60506-1404
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-907-3969
-----------------------------------------------------
Fax | 630-907-3998
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2085R0202X
-----------------------------------------------------
Taxonomy Name | Diagnostic Radiology Physician
-----------------------------------------------------
License Number | Q4281
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2085R0202X
-----------------------------------------------------
Taxonomy Name | Diagnostic Radiology Physician
-----------------------------------------------------
License Number | 036140889
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------