Provider Demographics
NPI:1780971333
Name:KOTINI-SHAH, PAVITRA (MD)
Entity type:Individual
Prefix:DR
First Name:PAVITRA
Middle Name:
Last Name:KOTINI-SHAH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:PAVITRA
Other - Middle Name:KOTINI
Other - Last Name:SHAH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:808 S WOOD ST # MC724
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-7300
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:914 S WOOD ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-7337
Practice Address - Country:US
Practice Address - Phone:248-898-2001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-05
Last Update Date:2019-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036134809207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine