Provider Demographics
NPI:1205920196
Name:SHAH, PRATIMA (MD)
Entity type:Individual
Prefix:
First Name:PRATIMA
Middle Name:
Last Name:SHAH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:839 BURNING TRL
Mailing Address - Street 2:
Mailing Address - City:CAROL STREAM
Mailing Address - State:IL
Mailing Address - Zip Code:60188-9148
Mailing Address - Country:US
Mailing Address - Phone:630-293-7737
Mailing Address - Fax:630-293-9239
Practice Address - Street 1:839 BURNING TRL
Practice Address - Street 2:
Practice Address - City:CAROL STREAM
Practice Address - State:IL
Practice Address - Zip Code:60188-9148
Practice Address - Country:US
Practice Address - Phone:630-293-7737
Practice Address - Fax:630-293-9239
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
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