Provider Demographics
NPI:1346287315
Name:SHAH, HETAL V (MD)
Entity Type:Individual
Prefix:
First Name:HETAL
Middle Name:V
Last Name:SHAH
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:355 W NORTHWEST HWY
Mailing Address - Street 2:
Mailing Address - City:PALATINE
Mailing Address - State:IL
Mailing Address - Zip Code:60067-2414
Mailing Address - Country:US
Mailing Address - Phone:847-255-7107
Mailing Address - Fax:847-255-7031
Practice Address - Street 1:5999 NEW WILKE RD
Practice Address - Street 2:SUITE 200, BLDG 2
Practice Address - City:ROLLING MEADOWS
Practice Address - State:IL
Practice Address - Zip Code:60008-4506
Practice Address - Country:US
Practice Address - Phone:847-255-7107
Practice Address - Fax:847-255-7031
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2018-09-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL036100898207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILH39854Medicare UPIN