Provider Demographics
NPI:1215248067
Name:SHAH, NIRAJ YATIN (MD)
Entity type:Individual
Prefix:DR
First Name:NIRAJ
Middle Name:YATIN
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 1:2025 S CHICAGO ST
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60436
Mailing Address - Country:US
Mailing Address - Phone:815-726-2200
Mailing Address - Fax:314-536-8783
Practice Address - Street 1:2025 S CHICAGO ST
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60436-3172
Practice Address - Country:US
Practice Address - Phone:815-726-2200
Practice Address - Fax:815-582-3253
Is Sole Proprietor?:No
Enumeration Date:2010-06-27
Last Update Date:2024-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125:058081207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine