MEDICARE: JAI DEVENDRA SHAH M.D., M.B.A., M.P.H.

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	2085R0204X	Vascular & Interventional Radiology Physician	036.121053	IL

General Provider Information

NPI Number	:	1740439009
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAI DEVENDRA SHAH M.D., M.B.A., M.P.H.

Provider Business Mailing Address
First Line	:	29373 NETWORK PL
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60673-1293
Country	:	US
Telephone Number	:	847-390-5900
Fax Number	:	847-390-4757

Provider Business Practice Location Address
First Line	:	801 S MILWAUKEE AVE
Second Line	:	ADVOCATE CONDELL MEDICAL CENTER - RADIOLOGY DEPARTMENT
City	:	LIBERTYVILLE
State	:	IL
Zip	:	60048-3204
Country	:	US
Telephone Number	:	847-990-5380
Fax Number	:	847-749-0696

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

Provider Enumeration Date	:	09/11/2008
Last Update Date	:	01/22/2026

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