Provider Demographics
NPI:1477602514
Name:DHRULATA R SHAH MDSC
Entity type:Organization
Organization Name:DHRULATA R SHAH MDSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DHRULATA
Authorized Official - Middle Name:R
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD MDSC
Authorized Official - Phone:847-961-6650
Mailing Address - Street 1:10821 CORTLAND LANE
Mailing Address - Street 2:DHRULATA R SHAH MDSC
Mailing Address - City:HUNTLEY
Mailing Address - State:IL
Mailing Address - Zip Code:60142-4076
Mailing Address - Country:US
Mailing Address - Phone:847-961-6650
Mailing Address - Fax:847-961-6650
Practice Address - Street 1:901 CENTER STREET
Practice Address - Street 2:SUITE 203
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60120-2104
Practice Address - Country:US
Practice Address - Phone:847-890-8562
Practice Address - Fax:847-429-2348
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty