Provider Demographics
NPI:1942688734
Name:SHAH, NEIL SAMIR (MD)
Entity Type:Individual
Prefix:DR
First Name:NEIL
Middle Name:SAMIR
Last Name:SHAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:SAMIR
Other - Middle Name:AMIL
Other - Last Name:SHAH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:71 WAUKEGAN RD STE 700
Mailing Address - Street 2:
Mailing Address - City:LAKE BLUFF
Mailing Address - State:IL
Mailing Address - Zip Code:60044-1614
Mailing Address - Country:US
Mailing Address - Phone:224-251-2020
Mailing Address - Fax:224-251-2010
Practice Address - Street 1:71 WAUKEGAN RD STE 700
Practice Address - Street 2:
Practice Address - City:LAKE BLUFF
Practice Address - State:IL
Practice Address - Zip Code:60044-1614
Practice Address - Country:US
Practice Address - Phone:224-251-2020
Practice Address - Fax:224-251-2010
Is Sole Proprietor?:No
Enumeration Date:2015-05-12
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036163007207W00000X
KS04-42656207WX0107X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist