Provider Demographics
NPI:1598920308
Name:SHAH, PURVI (MD)
Entity Type:Individual
Prefix:DR
First Name:PURVI
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 1:516 KEENEY ST
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60202-3044
Mailing Address - Country:US
Mailing Address - Phone:847-866-5762
Mailing Address - Fax:
Practice Address - Street 1:6810 N MCCORMICK BLVD
Practice Address - Street 2:LINCOLNWOOD PRIMARY CARE
Practice Address - City:LINCOLNWOOD
Practice Address - State:IL
Practice Address - Zip Code:60712-2709
Practice Address - Country:US
Practice Address - Phone:847-674-6900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-21
Last Update Date:2021-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036123606207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine