Provider Demographics
NPI:1174544951
Name:SHAH, BHARATI P IV (MD,)
Entity type:Individual
Prefix:DR
First Name:BHARATI
Middle Name:P
Last Name:SHAH
Suffix:IV
Gender:F
Credentials:MD,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 E GOLF RD
Mailing Address - Street 2:SUITE #117
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-1236
Mailing Address - Country:US
Mailing Address - Phone:847-391-6360
Mailing Address - Fax:
Practice Address - Street 1:1400 E GOLF RD
Practice Address - Street 2:SUITE # 117
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60016-1236
Practice Address - Country:US
Practice Address - Phone:847-391-6360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL711680Medicare ID - Type Unspecified
ILD15197Medicare UPIN