Provider Demographics
NPI:1700952140
Name:SHAH, DEVENDRA U (MD)
Entity Type:Individual
Prefix:DR
First Name:DEVENDRA
Middle Name:U
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 1:484 SUMMIT ST
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60120-3829
Mailing Address - Country:US
Mailing Address - Phone:847-742-5530
Mailing Address - Fax:847-695-6543
Practice Address - Street 1:484 SUMMIT ST
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60120-3829
Practice Address - Country:US
Practice Address - Phone:847-742-5530
Practice Address - Fax:847-695-6543
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207R00000X207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILAS9751391OtherDEA
ILAS9751391OtherDEA
ILD14426Medicare UPIN