Provider Demographics
NPI:1659576536
Name:SHAH, TEJAL UDAY (MD)
Entity Type:Individual
Prefix:DR
First Name:TEJAL
Middle Name:UDAY
Last Name:SHAH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:360 STATION DR STE 300
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-8003
Mailing Address - Country:US
Mailing Address - Phone:815-344-3900
Mailing Address - Fax:815-356-2388
Practice Address - Street 1:360 STATION DR STE 300
Practice Address - Street 2:
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-8003
Practice Address - Country:US
Practice Address - Phone:815-344-3900
Practice Address - Fax:815-356-2388
Is Sole Proprietor?:No
Enumeration Date:2007-06-19
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI53296-20207RE0101X
IL036147983207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism