Provider Demographics
NPI:1215965660
Name:SHAH, ATUL (MD)
Entity type:Individual
Prefix:
First Name:ATUL
Middle Name:
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:THREE SAINT ELIZABETH BLVD STE 2800
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:IL
Mailing Address - Zip Code:62269-1282
Mailing Address - Country:US
Mailing Address - Phone:618-233-6044
Mailing Address - Fax:833-973-4218
Practice Address - Street 1:THREE SAINT ELIZABETH BLVD STE 2800
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:IL
Practice Address - Zip Code:62269-1282
Practice Address - Country:US
Practice Address - Phone:618-233-6044
Practice Address - Fax:833-973-4218
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036084332207RI0011X
IL036-084332207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0360843321Medicaid
093363OtherHEALTH ALLIANCE
42767OtherCMR
12487OtherESSENCE
141631OtherUHC
37099690005OtherGHP
MO28281OtherBCBS MO
E57736OtherMERCY
060009694OtherRR MEDICARE
235177OtherWELLCARE
2507202OtherSECURE HORIZONS
189282OtherHEALTHLINK
IL0360843321Medicaid
12487OtherESSENCE
IL596500016Medicare PIN