Basic Information
| Provider Information | |||||||||
| NPI: | 1780840207 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHAH | ||||||||
| FirstName: | GAURAV | ||||||||
| MiddleName: | BIPIN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2088 OGDEN AVE STE 160 | ||||||||
| Address2: | |||||||||
| City: | AURORA | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605044383 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6308516440 | ||||||||
| FaxNumber: | 6308517001 | ||||||||
| Practice Location | |||||||||
| Address1: | 2088 OGDEN AVE | ||||||||
| Address2: | STE. 160 | ||||||||
| City: | AURORA | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605044376 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6308516440 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/04/2008 | ||||||||
| LastUpdateDate: | 07/21/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/21/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 036-122010 | IL | N | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207R00000X | 53064-021 | WI | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 125051920 | IL | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RC0000X | 5101018565 | MI | N | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207RI0011X | 036-083377 | IL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology |
No ID Information.