Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 019.032639 | IL |
Y | 213EG0000X | General Practice | 019.032639 | IL |
NPI | 1003430901 |
---|---|
Provider Name | Dr. Garima Shukla |
First Address | Aurora, IL 60502-7412 |
Second Address | Aurora, IL 60502-7412 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2020 |
Last Update Date | 26/06/2020 |