Provider Demographics
NPI:1053440503
Name:SHAH, RAJ C (MD)
Entity Type:Individual
Prefix:
First Name:RAJ
Middle Name:C
Last Name:SHAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:600 S PAULINA ST
Mailing Address - Street 2:SUITE 130
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-3806
Mailing Address - Country:US
Mailing Address - Phone:312-942-3333
Mailing Address - Fax:312-942-4154
Practice Address - Street 1:600 S PAULINA ST
Practice Address - Street 2:SUITE 130
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3806
Practice Address - Country:US
Practice Address - Phone:312-942-3333
Practice Address - Fax:312-942-4154
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2009-01-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036-1010452084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILH35286Medicare UPIN