Provider Demographics
NPI:1043412992
Name:SHAH, NISHANT A (MD)
Entity Type:Individual
Prefix:
First Name:NISHANT
Middle Name:A
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 1:820 S. DAMEN AVENUE
Mailing Address - Street 2:ANESTHESIOLOGY SERVICE ROOM 2672
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612
Mailing Address - Country:US
Mailing Address - Phone:312-569-6750
Mailing Address - Fax:
Practice Address - Street 1:820 S. DAMEN AVENUE
Practice Address - Street 2:ANESTHESIOLOGY SERVICE ROOM 2672
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612
Practice Address - Country:US
Practice Address - Phone:312-569-6750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-04
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036131644207L00000X
IL036.131644207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology