Provider Demographics
NPI:1073643193
Name:SHAH, MALATHI (MD)
Entity Type:Individual
Prefix:MRS
First Name:MALATHI
Middle Name:
Last Name:SHAH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:MALATHI
Other - Middle Name:
Other - Last Name:VENKATAPPAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:120 W 22ND ST STE 200
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1563
Mailing Address - Country:US
Mailing Address - Phone:630-573-5000
Mailing Address - Fax:
Practice Address - Street 1:1625 E 75TH ST STE 328
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60649-3603
Practice Address - Country:US
Practice Address - Phone:773-947-7841
Practice Address - Fax:773-493-1430
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036108396207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL922820004Medicare PIN
ILH41133Medicare UPIN