IndividualActive
Jitendra Shah, MD
NPI 1619061827 · Pediatric Cardiology Physician · Peoria, IL
Provider details
- NPI number
- 1619061827
- Entity type
- Individual
- Primary specialty
- Pediatric Cardiology PhysicianAllopathic & Osteopathic Physicians
- Credential
- MD
- Sex
- Male
- Sole proprietor
- No
- License
- 036-053972 (IL)
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Practice location
420 Ne Glen Oak Ave
Suite 304
Peoria, IL 61603-3105
Phone: (309) 655-3453
Fax: (309) 655-2938
Approximate (ZIP-level) locationGet directions
Mailing address
420 Ne Glen Oak Ave
Peoria, IL 61603-3105
Registry dates
- Enumerated
- 2006-10-03
- Last updated
- 2012-08-28
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.