Provider Demographics
NPI:1417096553
Name:SHAH, VIPIN A (ARRT, ARMRIT)
Entity Type:Individual
Prefix:MR
First Name:VIPIN
Middle Name:A
Last Name:SHAH
Suffix:
Gender:M
Credentials:ARRT, ARMRIT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1035 BOURNE LN
Mailing Address - Street 2:
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60193-2653
Mailing Address - Country:US
Mailing Address - Phone:630-400-8096
Mailing Address - Fax:
Practice Address - Street 1:821 E. SCHAUMBURG RD.
Practice Address - Street 2:
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60194
Practice Address - Country:US
Practice Address - Phone:630-400-8096
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL3057432471C3402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471C3402XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistRadiography