Provider Demographics
NPI:1316092026
Name:SHAH, JILAN (MD)
Entity type:Individual
Prefix:DR
First Name:JILAN
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 1:1010 BRICKELL AVE UNIT 2103
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33131-3766
Mailing Address - Country:US
Mailing Address - Phone:646-207-5799
Mailing Address - Fax:
Practice Address - Street 1:7000 SW 62ND AVE STE 320
Practice Address - Street 2:
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-4717
Practice Address - Country:US
Practice Address - Phone:305-740-6074
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2024-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY228373207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02440691Medicaid
NY02440691Medicaid
NY2X2482Medicare ID - Type UnspecifiedPROVIDER NUMBER