MEDICARE: AVANI SHETH

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	4301500556	MI
2	207Q00000X	Family Medicine Physician	MD60257660	WA
3	207QA0401X	Addiction Medicine (Family Medicine) Physician	036136479	IL
4	207Q00000X	Family Medicine Physician	249068	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1700047016
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AVANI SHETH

Provider Business Mailing Address
First Line	:	1431 N WESTERN AVE STE 401
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60622-7712
Country	:	US
Telephone Number	:	312-633-5841
Fax Number	:	312-491-5485

Provider Business Practice Location Address
First Line	:	1431 N WESTERN AVE
Second Line	:	SUITE 406
City	:	CHICAGO
State	:	IL
Zip	:	60622-1797
Country	:	US
Telephone Number	:	312-633-5841
Fax Number	:	312-491-5020

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

Provider Enumeration Date	:	06/19/2008
Last Update Date	:	03/24/2026

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Directions to “ AVANI SHETH ” Practice Location

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