MEDICARE: KINJAL U. SHAH M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	MD13574	RI
2	207R00000X	Internal Medicine Physician	036125411	IL

General Provider Information

NPI Number	:	1295937464
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KINJAL U. SHAH M.D.

Provider Business Mailing Address
First Line	:	130 N WEBER RD
Second Line	:
City	:	BOLINGBROOK
State	:	IL
Zip	:	60440-1518
Country	:	US
Telephone Number	:	630-646-5777
Fax Number	:	630-646-5729

Provider Business Practice Location Address
First Line	:	130 N WEBER RD
Second Line	:	STE 100
City	:	BOLINGBROOK
State	:	IL
Zip	:	60440-1518
Country	:	US
Telephone Number	:	630-646-5777
Fax Number	:	630-646-5729

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/01/2007
Last Update Date	:	06/17/2024

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