Individual
DR. JITENDRA J SHAH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
420 NE GLEN OAK AVE, SUITE 304, PEORIA, IL 61603-3105
(309) 655-3453
(309) 655-2938
Mailing address
420 NE GLEN OAK AVE, SUITE 304, PEORIA, IL 61603-3105
(309) 655-3453
(309) 655-2938
Taxonomy
Speciality
Code
Description
License number
State
2080P0202X
Pediatric Cardiology Physician
Primary
036-053972
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036053972
—
IL
Enumeration date
10/03/2006
Last updated
08/28/2012
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