Individual
RAJU KIRTIKUMAR SHAH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5101 WILLOW SPRINGS RD, 2ND FLOOR, LA GRANGE, IL 60525-2600
(708) 245-8900
(708) 245-5604
Mailing address
4461 PROGRESS BLVD, PERU, IL 61354-1109
(815) 223-9683
(815) 223-9683
Taxonomy
Speciality
Code
Description
License number
State
207QG0300X
Geriatric Medicine (Family Medicine) Physician
Primary
036143438
IL
390200000X
Student in an Organized Health Care Education/Training Program
125065796
IL
Other
Enumeration date
07/01/2014
Last updated
09/04/2018
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