Provider Demographics
NPI:1871748475
Name:SHAH, NIRAV GAUTAM (RT (N), (R), CNMT)
Entity type:Individual
Prefix:MR
First Name:NIRAV
Middle Name:GAUTAM
Last Name:SHAH
Suffix:
Gender:M
Credentials:RT (N), (R), CNMT
Other - Prefix:
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Mailing Address - Street 1:294 12TH ST
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:IL
Mailing Address - Zip Code:60090-2773
Mailing Address - Country:US
Mailing Address - Phone:847-420-6167
Mailing Address - Fax:
Practice Address - Street 1:4801 E LINWOOD BLVD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64128-2226
Practice Address - Country:US
Practice Address - Phone:816-861-4700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-24
Last Update Date:2008-11-24
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471N0900XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistNuclear Medicine Technology