Individual
KAVITA SHAH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
111 N COUNTY FARM RD, WHEATON, IL 60187-3977
(630) 682-7400
Mailing address
111 N COUNTY FARM RD, WHEATON, IL 60187-3988
(630) 712-4966
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
036-099281
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100273730
—
IL
Enumeration date
02/01/2007
Last updated
10/07/2021
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