Provider Demographics
NPI:1316910250
Name:SHAH, NIRANJANA (MD)
Entity type:Individual
Prefix:DR
First Name:NIRANJANA
Middle Name:
Last Name:SHAH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7101 W HIGGINS AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60656-1903
Mailing Address - Country:US
Mailing Address - Phone:773-763-6364
Mailing Address - Fax:773-792-9119
Practice Address - Street 1:7101 W HIGGINS AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60656-1903
Practice Address - Country:US
Practice Address - Phone:773-763-6364
Practice Address - Fax:773-792-9119
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-10
Last Update Date:2013-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036078000207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036078000Medicaid
IL036078000Medicaid