Provider Demographics
NPI:1003987298
Name:SHAH, KIRIT C (MD)
Entity Type:Individual
Prefix:DR
First Name:KIRIT
Middle Name:C
Last Name:SHAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6252 S ARCHER RD
Mailing Address - Street 2:
Mailing Address - City:SUMMIT
Mailing Address - State:IL
Mailing Address - Zip Code:60501-1720
Mailing Address - Country:US
Mailing Address - Phone:708-496-9549
Mailing Address - Fax:708-728-9429
Practice Address - Street 1:6252 S ARCHER RD
Practice Address - Street 2:
Practice Address - City:SUMMIT
Practice Address - State:IL
Practice Address - Zip Code:60501-1720
Practice Address - Country:US
Practice Address - Phone:708-496-9549
Practice Address - Fax:708-728-9429
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine