Individual
PRATISH AJAY SHAH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1025 S 6TH ST, SPRINGFIELD, IL 62703-2499
(217) 528-7541
Mailing address
PO BOX 19248, SPRINGFIELD, IL 62794-9248
(217) 528-7541
Taxonomy
Speciality
Code
Description
License number
State
2085N0700X
Neuroradiology Physician
Primary
036137694
IL
2085N0700X
Neuroradiology Physician
2020-02657
NC
2085R0202X
Diagnostic Radiology Physician
2020-02657
NC
Other
Enumeration date
04/09/2010
Last updated
04/22/2026
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