Provider Demographics
NPI:1134109861
Name:SHAH, NIKUNJ (MD)
Entity type:Individual
Prefix:
First Name:NIKUNJ
Middle Name:
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 1:840 S. WOOD ST. 1029 CSB BLDG.
Mailing Address - Street 2:UNIVERSITY OF ILLINOIS MEDICAL CENTER
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612
Mailing Address - Country:US
Mailing Address - Phone:312-413-9037
Mailing Address - Fax:312-996-1334
Practice Address - Street 1:840 S. WOOD ST.
Practice Address - Street 2:UNIVERSITY OF ILLINOIS MEDICAL CENTER
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612
Practice Address - Country:US
Practice Address - Phone:312-413-9037
Practice Address - Fax:312-996-1334
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36051792207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILL99678OtherMEDICARE
IL36051792Medicaid
IL36051792Medicaid
ILL99678OtherMEDICARE