Provider Demographics
NPI:1093821704
Name:SHAH, BHARATI B (MD)
Entity Type:Individual
Prefix:DR
First Name:BHARATI
Middle Name:B
Last Name:SHAH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3502 MAPLE LEAF DR
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60026-1131
Mailing Address - Country:US
Mailing Address - Phone:847-824-2161
Mailing Address - Fax:847-824-1042
Practice Address - Street 1:496 LEE ST
Practice Address - Street 2:
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60016-4607
Practice Address - Country:US
Practice Address - Phone:847-824-2161
Practice Address - Fax:824-824-1042
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL21604660OtherBLUE COSS & BLUE SHIELD
IL036-046339-1OtherILLINOIS LICENSE
IL21604660OtherBLUE COSS & BLUE SHIELD