Provider Demographics
NPI:1336301027
Name:BEHARA, AMI SHAH (MD)
Entity Type:Individual
Prefix:DR
First Name:AMI
Middle Name:SHAH
Last Name:BEHARA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:AMI
Other - Middle Name:RUPAK
Other - Last Name:SHAH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:199 W RAND RD
Mailing Address - Street 2:
Mailing Address - City:MT PROSPECT
Mailing Address - State:IL
Mailing Address - Zip Code:60056-1151
Mailing Address - Country:US
Mailing Address - Phone:847-725-8640
Mailing Address - Fax:847-618-5459
Practice Address - Street 1:199 W RAND RD
Practice Address - Street 2:
Practice Address - City:MT PROSPECT
Practice Address - State:IL
Practice Address - Zip Code:60056-1151
Practice Address - Country:US
Practice Address - Phone:847-725-8640
Practice Address - Fax:847-618-5459
Is Sole Proprietor?:No
Enumeration Date:2008-06-25
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036115299207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology