Provider Demographics
NPI:1861485930
Name:SHAH, DILIP KANTILAL (MD)
Entity Type:Individual
Prefix:DR
First Name:DILIP
Middle Name:KANTILAL
Last Name:SHAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1 S GREENLEAF ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-3370
Mailing Address - Country:US
Mailing Address - Phone:847-336-7424
Mailing Address - Fax:847-336-8776
Practice Address - Street 1:1 S GREENLEAF ST
Practice Address - Street 2:SUITE D
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-3370
Practice Address - Country:US
Practice Address - Phone:847-336-7424
Practice Address - Fax:847-336-8776
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-24
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036059628207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
02201467OtherBC/BS
710690Medicare ID - Type Unspecified
D15179Medicare UPIN