Individual
DR. VIBHAKAR SHANTILAL SHAH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
222 S GREENLEAF ST, SUITE NO. 109, GURNEE, IL 60031-5705
(847) 249-0167
(847) 249-0717
Mailing address
222 S GREENLEAF ST, SUITE NO. 109, GURNEE, IL 60031-5705
(847) 249-0167
(847) 249-0717
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
036053632
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0004900801
BC/BS
IL
05
—
036053632
—
IL
01
—
791041099
RR MEDICARE
IL
01
—
L009488
TRICARE
IL
Enumeration date
10/12/2005
Last updated
01/11/2008
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