Provider Demographics
NPI:1013173681
Name:SHAH, AMAR PRAVIN (MD)
Entity Type:Individual
Prefix:DR
First Name:AMAR
Middle Name:PRAVIN
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 1:1725 W HARRISON ST STE 461
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-3866
Mailing Address - Country:US
Mailing Address - Phone:312-942-5781
Mailing Address - Fax:
Practice Address - Street 1:1725 W HARRISON ST STE 461
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3866
Practice Address - Country:US
Practice Address - Phone:312-942-5781
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-04
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILAP3881528713732085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology