Provider Demographics
NPI:1891842506
Name:VIRANI, SHAILESH R (MD)
Entity Type:Individual
Prefix:DR
First Name:SHAILESH
Middle Name:R
Last Name:VIRANI
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 1:348 S DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:HARVARD
Mailing Address - State:IL
Mailing Address - Zip Code:60033-3247
Mailing Address - Country:US
Mailing Address - Phone:815-943-1122
Mailing Address - Fax:
Practice Address - Street 1:348 S DIVISION ST
Practice Address - Street 2:
Practice Address - City:HARVARD
Practice Address - State:IL
Practice Address - Zip Code:60033-3247
Practice Address - Country:US
Practice Address - Phone:815-943-1122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036107941 1Medicaid
IL036107941 1Medicaid
IL214660 K02613Medicare ID - Type Unspecified