Healthcare Provider Details

I. General information

NPI: 1841601986
Provider Name (Legal Business Name): PRATEEK SHUKLA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2014
Last Update Date: 07/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 MICHIGAN AVE NW PULMONARY DEPARTMENT
WASHINGTON DC
20010-2916
US

IV. Provider business mailing address

1413 K ST SE
WASHINGTON DC
20003-3235
US

V. Phone/Fax

Practice location:
  • Phone: 202-476-6399
  • Fax:
Mailing address:
  • Phone: 650-696-0868
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number363439
License Number StateZZ
# 2
Primary TaxonomyY
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License NumberMTL002120
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: