Provider Demographics
NPI:1346498292
Name:SHAH, ARPIT SURESH (DO)
Entity Type:Individual
Prefix:
First Name:ARPIT
Middle Name:SURESH
Last Name:SHAH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:88 SILO RIDGE RD W
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60467-7331
Mailing Address - Country:US
Mailing Address - Phone:708-460-8605
Mailing Address - Fax:708-310-4320
Practice Address - Street 1:8012 S CRANDON AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60617-1124
Practice Address - Country:US
Practice Address - Phone:708-356-5415
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-04
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036121414207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036121414OtherLICENSE NUMBER
IL4673170001OtherDMERC GROUP
IL036121414OtherLICENSE NUMBER
IL4673170001OtherDMERC GROUP
IL203979003/203979Medicare PIN