Basic Information
| Provider Information | |||||||||
| NPI: | 1871700096 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHAH | ||||||||
| FirstName: | NIRANJAN | ||||||||
| MiddleName: | CHAMPAKLAL | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1151 STANFORD AVENUE | ||||||||
| Address2: | |||||||||
| City: | DOWNERS GROVE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605163349 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6309636858 | ||||||||
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| Practice Location | |||||||||
| Address1: | 12632 S HARLEM AVE | ||||||||
| Address2: | |||||||||
| City: | PALOS HEIGHTS | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604631428 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7085870000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/17/2007 | ||||||||
| LastUpdateDate: | 01/04/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/31/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 036060894 | IL | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.