Healthcare Provider Details

I. General information

NPI: 1669829826
Provider Name (Legal Business Name): ANUJ SHUKLA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2016
Last Update Date: 02/10/2025
Certification Date: 02/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 HOSPITAL LN STE 100
DANVILLE IN
46122-1993
US

IV. Provider business mailing address

1100 SOUTHFIELD DR STE 1370
PLAINFIELD IN
46168-4300
US

V. Phone/Fax

Practice location:
  • Phone: 317-718-4000
  • Fax:
Mailing address:
  • Phone: 317-837-5566
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number01087803A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: