Provider Demographics
NPI:1689674970
Name:SHAH, DHRULATA R (MD)
Entity type:Individual
Prefix:DR
First Name:DHRULATA
Middle Name:R
Last Name:SHAH
Suffix:
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 1:10821 CORTLAND LN
Mailing Address - Street 2:
Mailing Address - City:HUNTLEY
Mailing Address - State:IL
Mailing Address - Zip Code:60142-4076
Mailing Address - Country:US
Mailing Address - Phone:847-961-6550
Mailing Address - Fax:
Practice Address - Street 1:901 CENTER ST
Practice Address - Street 2:SUITE 203
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60120-2104
Practice Address - Country:US
Practice Address - Phone:847-890-8562
Practice Address - Fax:847-429-2348
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL203128Medicare ID - Type UnspecifiedMEDICARE NUM DU PAGE
IL567100Medicare ID - Type UnspecifiedMEDICARE NUM COOK
ILG19341Medicare UPIN