Provider Demographics
NPI:1902012008
Name:SHAH, ANUJ KUMAR (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:ANUJ
Middle Name:KUMAR
Last Name:SHAH
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3154 N CLARK ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-4437
Mailing Address - Country:US
Mailing Address - Phone:312-666-3494
Mailing Address - Fax:773-276-0749
Practice Address - Street 1:3154 N CLARK ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-4437
Practice Address - Country:US
Practice Address - Phone:312-666-3494
Practice Address - Fax:773-276-0749
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036120985207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine