Organization
DR. YOGENDRA A. SHAH, MD. SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. YOGENDRA AMBALAL SHAH M.D. (GYN)
(618) 451-7717
Entity
Organization
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
06/20/2012
Last updated
06/20/2012
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