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NPI Code Detail

MEDICARE: YATIN M SHAH MD SC

MEDICARE: YATIN M SHAH MD SC
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
1174400000XSpecialist209005700IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1209006800OTHERILAPN LICENSE

General Provider Information

NPI Number : 1497851703
Entity Type Code : Organization
Provider Name (Legal Business Name) : YATIN M SHAH MD SC
Provider Business Mailing Address
First Line : 2025 S CHICAGO ST
Second Line :
City : JOLIET
State : IL
Zip : 60436-3172
Country : US
Telephone Number : 815-726-2200
Fax Number : 815-727-1442
Provider Business Practice Location Address
First Line : 2025 S CHICAGO ST
Second Line :
City : JOLIET
State : IL
Zip : 60436-3172
Country : US
Telephone Number : 815-726-2200
Fax Number : 815-727-1442
Authorized Official
Title or Position : PRACTICE MANAGER
Name : MITI G SHAH
Credential :
Telephone Number : 815-726-2200
Provider Enumeration Date : 09/15/2006
Last Update Date : 10/19/2018

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Directions to “YATIN M SHAH MD SC ” Practice Location

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