Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 036.138823 | IL |
N | 208600000X | Surgeon | 036.138823 | IL |
Y | 2086X0206X | Surgical Oncologist | 036.138823 | IL |
NPI | 1306078910 |
---|---|
Provider Name | Dr. Bhavin Chandrakant Shah |
First Address | Naperville, IL 60540 |
Second Address | Joliet, IL 60435-6995 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/08/2009 |
Last Update Date | 26/06/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036138823 | (05) | IL |
F400259208 | MEDICARE PTAN (01) | IL |