Provider Demographics
NPI:1780840207
Name:SHAH, GAURAV BIPIN (DO)
Entity type:Individual
Prefix:DR
First Name:GAURAV
Middle Name:BIPIN
Last Name:SHAH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2088 OGDEN AVE STE 160
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60504-4383
Mailing Address - Country:US
Mailing Address - Phone:630-851-6440
Mailing Address - Fax:630-851-7001
Practice Address - Street 1:2088 OGDEN AVE
Practice Address - Street 2:STE. 160
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60504-4376
Practice Address - Country:US
Practice Address - Phone:630-851-6440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-04
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-122010207RC0000X
WI53064-021207R00000X
IL125051920207R00000X
MI5101018565207RC0000X
IL036-083377207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI700E031600OtherBCBSM GROUP
MI0N40170Medicare PIN
ILF400153706Medicare PIN