Individual
KETAN SHAH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1000 ELEVEN S, STE 4F, COLUMBIA, IL 62236-1080
(618) 628-0715
(888) 371-4468
Mailing address
1000 ELEVEN S, STE 4F, COLUMBIA, IL 62236-1080
(618) 628-0715
(888) 371-4468
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
036-101869
IL
Other
Enumeration date
08/22/2006
Last updated
05/18/2020
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