Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080N0001X | Neonatal-Perinatal Doctor | 036-061920 | IL |
NPI | 1033156385 |
---|---|
Provider Name | Arvind Shukla |
First Address | Oak Brook, IL 60523-2213 |
Second Address | Oak Brook, IL 60523-2213 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/06/2006 |
Last Update Date | 15/06/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036-061920 | (05) | IL |
H27760 | (02) | IL |