Healthcare Provider Details

I. General information

NPI: 1508181140
Provider Name (Legal Business Name): SHILPA IYER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2010
Last Update Date: 07/22/2024
Certification Date: 07/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 W TAYLOR ST
CHICAGO IL
60612-4795
US

IV. Provider business mailing address

820 S WOOD ST # MC808
CHICAGO IL
60612-4325
US

V. Phone/Fax

Practice location:
  • Phone: 312-413-7500
  • Fax:
Mailing address:
  • Phone:
  • Fax: 312-996-4238

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License Number036134769
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: