Provider Demographics
NPI:1992961494
Name:SHAH, SAMIR RAJENDRA (MD)
Entity type:Individual
Prefix:DR
First Name:SAMIR
Middle Name:RAJENDRA
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 1:737 W WASHINGTON BLVD
Mailing Address - Street 2:UNIT 3007
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60661-2173
Mailing Address - Country:US
Mailing Address - Phone:312-589-1002
Mailing Address - Fax:
Practice Address - Street 1:737 W WASHINGTON BLVD
Practice Address - Street 2:UNIT 3007
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60661-2173
Practice Address - Country:US
Practice Address - Phone:312-589-1002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-04
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.120651208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery