Provider Demographics
NPI:1972730893
Name:SHAH, MIHIR B (DO)
Entity type:Individual
Prefix:
First Name:MIHIR
Middle Name:B
Last Name:SHAH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1221 N HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60506-1404
Mailing Address - Country:US
Mailing Address - Phone:630-907-3969
Mailing Address - Fax:630-907-3998
Practice Address - Street 1:1221 N HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60506-1404
Practice Address - Country:US
Practice Address - Phone:630-907-3969
Practice Address - Fax:630-907-3998
Is Sole Proprietor?:No
Enumeration Date:2009-06-18
Last Update Date:2016-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ42812085R0202X
IL0361408892085R0202X
FL390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX407299YSHDOtherSTRIC - MEDICARE
TXP01473738OtherSTRIC - RR MEDICARE
TX3462442-02OtherSTRG - MEDICAID
TXP01473741OtherSTRG - RR MEDICARE
TX3462442-03OtherSTRG - MEDICAID - CSHCN
TX407299YSHEOtherSTRG - MEDICARE
TX3462442-01OtherSTRIC - MEDICAID
TXQ4281OtherTEXAS MEDICAL LICENSE