Individual
DR. YOGENDRA AMBALAL SHAH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.,S.C.
Contact information
Practice address
3165 MYRTLE AVE, GRANITE CITY, IL 62040-5012
(618) 451-7717
(618) 451-7780
Mailing address
3165 MYRTLE AVE, GRANITE CITY, IL 62040-5012
(618) 451-7717
(618) 451-7780
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
036048989
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036048989
—
IL
Enumeration date
03/18/2007
Last updated
07/08/2007
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