Provider Demographics
NPI:1871752881
Name:BATRA, SHIVANI SHAH (DO)
Entity type:Individual
Prefix:
First Name:SHIVANI
Middle Name:SHAH
Last Name:BATRA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:SHIVANI
Other - Middle Name:GAURANG
Other - Last Name:SHAH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:3000 N HALSTED ST STE 525
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-9269
Mailing Address - Country:US
Mailing Address - Phone:773-433-3130
Mailing Address - Fax:
Practice Address - Street 1:3000 N HALSTED ST STE 525
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-9269
Practice Address - Country:US
Practice Address - Phone:773-433-3130
Practice Address - Fax:773-433-3127
Is Sole Proprietor?:No
Enumeration Date:2008-06-04
Last Update Date:2019-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0361315522081P2900X
NY261190-12081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
No2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036131552OtherSTATE OF ILLINOIS LICENSE NUMBER