Provider Demographics
NPI:1063707073
Name:SHAH, RAJAN V (MD)
Entity type:Individual
Prefix:
First Name:RAJAN
Middle Name:V
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 1:199 SCOTT ST FL 8
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14204-2208
Mailing Address - Country:US
Mailing Address - Phone:917-261-4414
Mailing Address - Fax:
Practice Address - Street 1:131 S DEARBORN ST STE 1025
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60603-5517
Practice Address - Country:US
Practice Address - Phone:917-261-4414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-17
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC188638207R00000X
TXU6897207R00000X
NY318467207R00000X
MDD98635207R00000X
IL036.136013207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF400216892Medicare PIN