Provider Demographics
NPI:1164985883
Name:SHAH, DEEP N (DPM, MBA)
Entity type:Individual
Prefix:DR
First Name:DEEP
Middle Name:N
Last Name:SHAH
Suffix:
Gender:M
Credentials:DPM, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1004 TUSCANY DR
Mailing Address - Street 2:
Mailing Address - City:STREAMWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60107-4529
Mailing Address - Country:US
Mailing Address - Phone:518-330-7689
Mailing Address - Fax:
Practice Address - Street 1:183 W 1ST ST
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-2815
Practice Address - Country:US
Practice Address - Phone:630-530-3338
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-09
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016.005976213ES0103X, 213ES0131X, 213EP1101X, 213ER0200X, 213ES0000X
PASC007033213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ER0200XPodiatric Medicine & Surgery Service ProvidersPodiatristRadiology
No213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports Medicine