Individual
BIRAJ M. SHAH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S., M.D.
Contact information
Practice address
1900 W POLK ST STE 612, CHICAGO, IL 60612
(312) 864-3202
Mailing address
1900 W POLK ST STE 612, CHICAGO, IL 60612-3723
(312) 864-3202
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
019.031724
IL
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
036147405
IL
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
036-147405
IL
Other
Enumeration date
02/25/2012
Last updated
03/03/2026
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