Provider Demographics
NPI:1740439009
Name:SHAH, JAI DEVENDRA (MD, MBA, MPH)
Entity type:Individual
Prefix:
First Name:JAI
Middle Name:DEVENDRA
Last Name:SHAH
Suffix:
Gender:M
Credentials:MD, MBA, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:801 S MILWAUKEE AVE
Mailing Address - Street 2:
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048-3204
Mailing Address - Country:US
Mailing Address - Phone:847-362-2900
Mailing Address - Fax:
Practice Address - Street 1:801 S MILWAUKEE AVE
Practice Address - Street 2:ADVOCATE CONDELL MEDICAL CENTER - RADIOLOGY DEPARTMENT
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-3204
Practice Address - Country:US
Practice Address - Phone:847-990-5380
Practice Address - Fax:847-749-0696
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-11
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.1210532085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology