NPIMap

Organization Active NPI

Vibhakar S Shah M.D., S.C.

  • Specialist
  • Gurnee, IL
National Provider Identifier
1467647099
Registry record updated Jan 22, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
VIBHAKAR S SHAH M.D., S.C.
Practice address
222 S Greenleaf St
Suite #109
Gurnee, IL 60031-5705
Phone
(847) 249-0167
Fax
(847) 249-0717
NPI assigned
Sep 6, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 22, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Vibhakar S Shah, M.D.NPI 1649268780
Title
Owner
Phone
(847) 249-0167

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X IL Primary

Addresses

Primary practice location

222 S Greenleaf St
Suite #109
Gurnee, IL 60031-5705

Mailing address

222 S Greenleaf St
Suite #109
Gurnee, IL 60031-5705
Phone (847) 249-0167

National Provider Directory

National Provider Directory

Locations

222 S Greenleaf St
Ste 109
Gurnee, IL 60031
Phone (847) 249-0167

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1189036800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1200960000000",
    "number": "1467647099",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "222 S GREENLEAF ST",
            "address_2": "SUITE #109",
            "city": "GURNEE",
            "state": "IL",
            "postal_code": "600315705",
            "telephone_number": "847-249-0167",
            "fax_number": "847-249-0717"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "222 S GREENLEAF ST",
            "address_2": "SUITE #109",
            "city": "GURNEE",
            "state": "IL",
            "postal_code": "600315705",
            "telephone_number": "847-249-0167",
            "fax_number": "847-249-0717"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VIBHAKAR S SHAH M.D., S.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-06",
        "last_updated": "2008-01-22",
        "status": "A",
        "authorized_official_last_name": "SHAH",
        "authorized_official_first_name": "VIBHAKAR",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "847-249-0167",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gurnee, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.