Provider Demographics
NPI:1861671844
Name:SHAH, HEMANT B (MD)
Entity Type:Individual
Prefix:
First Name:HEMANT
Middle Name:B
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 1:1420 RENAISSANCE DRIVE
Mailing Address - Street 2:STE 307
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-1343
Mailing Address - Country:US
Mailing Address - Phone:847-803-1000
Mailing Address - Fax:847-803-1098
Practice Address - Street 1:1420 RENAISSANCE DRIVE
Practice Address - Street 2:STE 307
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-1343
Practice Address - Country:US
Practice Address - Phone:847-803-1000
Practice Address - Fax:847-803-1098
Is Sole Proprietor?:No
Enumeration Date:2007-10-26
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI48369020390200000X
OH35-0926372085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP00729457OtherRAILROAD MEDICARE
OH2943739Medicaid
OHSH4263181Medicare PIN