Provider Demographics
NPI:1669967683
Name:SHAH, AYUSH N (DO)
Entity type:Individual
Prefix:
First Name:AYUSH
Middle Name:N
Last Name:SHAH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2650 RIDGE AVE.
Mailing Address - Street 2:IM HOSPITALISTS STE 4210
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-1700
Mailing Address - Country:US
Mailing Address - Phone:847-570-1010
Mailing Address - Fax:847-733-5108
Practice Address - Street 1:2650 RIDGE AVE.
Practice Address - Street 2:IM HOSPITALISTS STE 4210
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-1700
Practice Address - Country:US
Practice Address - Phone:847-570-1010
Practice Address - Fax:847-733-5108
Is Sole Proprietor?:No
Enumeration Date:2018-06-22
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125.072720207R00000X
IL036.154823207R00000X
IL036154823208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine