Provider Demographics
NPI:1023007143
Name:SHAH, NEILESH (MD)
Entity Type:Individual
Prefix:
First Name:NEILESH
Middle Name:
Last Name:SHAH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:18440 THOMPSON CT
Mailing Address - Street 2:105
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60477-5390
Mailing Address - Country:US
Mailing Address - Phone:708-532-6029
Mailing Address - Fax:708-532-6095
Practice Address - Street 1:17850 KEDZIE AVE
Practice Address - Street 2:3200
Practice Address - City:HAZEL CREST
Practice Address - State:IL
Practice Address - Zip Code:60429-2058
Practice Address - Country:US
Practice Address - Phone:708-798-8112
Practice Address - Fax:708-798-9016
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2021-12-20
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Provider Licenses
StateLicense IDTaxonomies
IL036113251207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036113251Medicaid