Provider Demographics
NPI:1508362054
Name:SHAH, REEMA (MD)
Entity Type:Individual
Prefix:
First Name:REEMA
Middle Name:
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 1:312 BRODIE CT
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-8288
Mailing Address - Country:US
Mailing Address - Phone:630-386-0648
Mailing Address - Fax:
Practice Address - Street 1:LAGRANGE PEDIATRICS
Practice Address - Street 2:4727 WILLOW SPRINGS RD
Practice Address - City:LAGRANGE
Practice Address - State:IL
Practice Address - Zip Code:60525
Practice Address - Country:US
Practice Address - Phone:708-588-0088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-03
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty