Individual
DR. SAMIR K SHAH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
6810 STATE ROUTE 162 STE 102, MARYVILLE, IL 62062-8560
(618) 288-4076
(618) 288-4215
Mailing address
PO BOX 959203, SAINT LOUIS, MO 63195-9203
(618) 288-4076
(618) 288-4215
Taxonomy
Speciality
Code
Description
License number
State
207RA0000X
Adolescent Medicine (Internal Medicine) Physician
036-063403
IL
207RC0000X
Cardiovascular Disease Physician
Primary
036-063403
IL
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
036-063403
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01636052
BCBS
IL
05
—
036063403
—
IL
Enumeration date
07/27/2006
Last updated
11/25/2025
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