Healthcare Provider Details

I. General information

NPI: 1477904035
Provider Name (Legal Business Name): ADARSH SHUKLA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2016
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4354 W 63RD ST
CHICAGO IL
60629-5039
US

IV. Provider business mailing address

9680 GOLF RD
DES PLAINES IL
60016-1522
US

V. Phone/Fax

Practice location:
  • Phone: 773-482-5800
  • Fax:
Mailing address:
  • Phone: 773-482-5800
  • Fax: 773-767-9604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number036156459
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number01092486A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: