Provider Demographics
NPI:1497919450
Name:SHAH, KAIRAV (MD)
Entity Type:Individual
Prefix:DR
First Name:KAIRAV
Middle Name:
Last Name:SHAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 MCCLINTOCK DR STE 202
Mailing Address - Street 2:
Mailing Address - City:BURR RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60527-0872
Mailing Address - Country:US
Mailing Address - Phone:630-654-4201
Mailing Address - Fax:630-654-4253
Practice Address - Street 1:7444 HANNOVER PKWY S STE 210
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-7847
Practice Address - Country:US
Practice Address - Phone:770-741-1750
Practice Address - Fax:770-741-1755
Is Sole Proprietor?:No
Enumeration Date:2008-07-17
Last Update Date:2018-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA81208207RI0200X
FLTRN# 16995207RI0200X
FLME119930207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL011920900Medicaid
FL011920900Medicaid