MEDICARE: DR. DHRULATA R 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	207Q00000X	Family Medicine Physician		IL

General Provider Information

NPI Number	:	1689674970
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DHRULATA R SHAH M.D.

Provider Business Mailing Address
First Line	:	10821 CORTLAND LN
Second Line	:
City	:	HUNTLEY
State	:	IL
Zip	:	60142-4076
Country	:	US
Telephone Number	:	847-961-6550
Fax Number	:

Provider Business Practice Location Address
First Line	:	901 CENTER ST
Second Line	:	SUITE 203
City	:	ELGIN
State	:	IL
Zip	:	60120-2104
Country	:	US
Telephone Number	:	847-890-8562
Fax Number	:	847-429-2348

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

Provider Enumeration Date	:	07/28/2005
Last Update Date	:	07/09/2007

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Directions to “ DR. DHRULATA R SHAH M.D.” Practice Location

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