Provider Demographics
NPI:1497084594
Name:SHAH, ADITI HARSHAD (MD)
Entity Type:Individual
Prefix:DR
First Name:ADITI
Middle Name:HARSHAD
Last Name:SHAH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22611 N FOXTAIL DR
Mailing Address - Street 2:
Mailing Address - City:KILDEER
Mailing Address - State:IL
Mailing Address - Zip Code:60047-1818
Mailing Address - Country:US
Mailing Address - Phone:476-436-7908
Mailing Address - Fax:
Practice Address - Street 1:22611 N FOXTAIL DR
Practice Address - Street 2:
Practice Address - City:KILDEER
Practice Address - State:IL
Practice Address - Zip Code:60047-1818
Practice Address - Country:US
Practice Address - Phone:476-436-7908
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-18
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036124432208M00000X
IL036.124432207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036124432Medicaid
IL036124432Medicaid