Provider Demographics
NPI:1528455565
Name:SHAH, BIREN (DPM)
Entity type:Individual
Prefix:DR
First Name:BIREN
Middle Name:
Last Name:SHAH
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6090 STRATHMOOR DR
Mailing Address - Street 2:STE 6
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61107-5200
Mailing Address - Country:US
Mailing Address - Phone:815-282-8145
Mailing Address - Fax:815-282-2602
Practice Address - Street 1:6090 STRATHMOOR DR STE 6
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107-5200
Practice Address - Country:US
Practice Address - Phone:815-282-8145
Practice Address - Fax:815-282-2602
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-16
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO 3727213ES0103X
FL390200000X
IL016.005692213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program