Healthcare Provider Details

I. General information

NPI: 1912937178
Provider Name (Legal Business Name): SHRI K AGRAWAL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2701 W 68TH ST 2 S.PAVILION
CHICAGO IL
60629-1813
US

IV. Provider business mailing address

2701 W 68TH ST 2 S.PAVILION
CHICAGO IL
60629-1813
US

V. Phone/Fax

Practice location:
  • Phone: 773-884-7920
  • Fax:
Mailing address:
  • Phone: 773-884-7920
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: