Individual
DR. BHAVIN CHANDRAKANT SHAH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
301 MADISON ST STE 302, JOLIET, IL 60435-6995
(815) 582-3177
(815) 582-3754
Mailing address
1435 KALLIEN AVE., NAPERVILLE, IL 60540
(815) 582-3177
(815) 582-3754
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
036.138823
IL
2086X0206X
Surgical Oncology Physician
Primary
036.138823
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036138823
—
IL
01
—
F400259208
MEDICARE PTAN
IL
Enumeration date
08/14/2009
Last updated
06/26/2017
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