Shah, Jitendra J

Shah, Jitendra J is an individual health care provider with primary practice located at 420 Ne Glen Oak Ave Suite 304, Peoria IL 61603-3105. He recently has only one registered license in Allopathic & Osteopathic Physicians / Pediatric Cardiology, which is considered as his primary health care specialty. Shah, Jitendra J can be contacted via phone (309) 655-3453.

Contact Information

Primary practice address
420 Ne Glen Oak Ave Suite 304 Peoria IL 61603-3105
Phone: (309) 655-3453
Fax: (309) 655-2938
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Pediatric Cardiology 2080P0202X 036-053972 Illinois

Profile Details

NPI number 1619061827
LBN Legal business name Shah, Jitendra J
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 3rd, 2006
Last updated Aug 28th, 2012 - about 12 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1619061827 NPPES
Illinois MEDICAID 036053972

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