Provider Demographics
NPI:1699868455
Name:SHAH, VINEET PURUSHOTTAM (DO, MPH)
Entity type:Individual
Prefix:DR
First Name:VINEET
Middle Name:PURUSHOTTAM
Last Name:SHAH
Suffix:
Gender:M
Credentials:DO, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29373 NETWORK PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60673-1293
Mailing Address - Country:US
Mailing Address - Phone:847-390-5900
Mailing Address - Fax:847-390-4757
Practice Address - Street 1:3021 N SHEFFIELD AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-4419
Practice Address - Country:US
Practice Address - Phone:872-843-0550
Practice Address - Fax:872-873-9070
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2022-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-116622207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK33919Medicare PIN
I66163Medicare UPIN
ILK33918Medicare PIN