MEDICARE: BHARAT K SHAH MD

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	207Q00000X	Family Medicine Physician	036068419	IL

General Provider Information

NPI Number	:	1316971005
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BHARAT K SHAH MD

Provider Business Mailing Address
First Line	:	3414 W PETERSON AVE
Second Line	:	SUITE A
City	:	CHICAGO
State	:	IL
Zip	:	60659
Country	:	US
Telephone Number	:	773-478-1777
Fax Number	:	773-478-1964

Provider Business Practice Location Address
First Line	:	3414 W PETERSON
Second Line	:	SUITE A
City	:	CHICAGO
State	:	IL
Zip	:	60659
Country	:	US
Telephone Number	:	773-478-1777
Fax Number	:	877-224-8985

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

Provider Enumeration Date	:	07/10/2006
Last Update Date	:	07/14/2025

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