Provider Demographics
NPI:1225152929
Name:SHAH, BHARAT KANTILAL (MD)
Entity Type:Individual
Prefix:DR
First Name:BHARAT
Middle Name:KANTILAL
Last Name:SHAH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:16387 WYNNCREST FALLS WAY
Mailing Address - Street 2:
Mailing Address - City:WILDWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63005
Mailing Address - Country:US
Mailing Address - Phone:636-272-6978
Mailing Address - Fax:309-272-1583
Practice Address - Street 1:950 N KINGSHIGHWAY
Practice Address - Street 2:
Practice Address - City:EAST SAINT LOUIS
Practice Address - State:IL
Practice Address - Zip Code:62203-1085
Practice Address - Country:US
Practice Address - Phone:618-394-2200
Practice Address - Fax:618-394-5672
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL36049764208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery