Provider Demographics
NPI:1225138142
Name:SHAH, ARUNA S (MD)
Entity Type:Individual
Prefix:
First Name:ARUNA
Middle Name:S
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 1:419 N MULFORD RD
Mailing Address - Street 2:STE. #1
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61107-5197
Mailing Address - Country:US
Mailing Address - Phone:815-229-9095
Mailing Address - Fax:
Practice Address - Street 1:419 N MULFORD RD
Practice Address - Street 2:STE. #1
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107-5197
Practice Address - Country:US
Practice Address - Phone:815-229-9095
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF39065Medicare UPIN