Provider Demographics
NPI:1891736492
Name:SHAH, VIJAY J (MD)
Entity Type:Individual
Prefix:DR
First Name:VIJAY
Middle Name:J
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 1:1320 N HIGHLAND AVE STE B
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60506-1469
Mailing Address - Country:US
Mailing Address - Phone:630-892-4286
Mailing Address - Fax:630-892-2104
Practice Address - Street 1:1320 N HIGHLAND AVE
Practice Address - Street 2:SUITE A
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60506-1403
Practice Address - Country:US
Practice Address - Phone:630-896-0659
Practice Address - Fax:630-896-0581
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036074019207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL060069376OtherRAILROAD MEDICARE
IL036074019Medicaid
ILL52195Medicare ID - Type Unspecified
IL060069376Medicare PIN
IL060069376OtherRAILROAD MEDICARE
C44813Medicare UPIN
IL036074019Medicaid