Provider Demographics
NPI:1215216155
Name:SHAH, SAMIT B (DO)
Entity Type:Individual
Prefix:DR
First Name:SAMIT
Middle Name:B
Last Name:SHAH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:5115 N FRANCISCO AVE
Mailing Address - Street 2:FL 1
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-3611
Mailing Address - Country:US
Mailing Address - Phone:773-271-6622
Mailing Address - Fax:773-271-6801
Practice Address - Street 1:5115 N FRANCISCO AVE
Practice Address - Street 2:FL 1
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-3611
Practice Address - Country:US
Practice Address - Phone:773-271-6622
Practice Address - Fax:773-271-6801
Is Sole Proprietor?:No
Enumeration Date:2011-08-09
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036136011207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine