Healthcare Provider Details

I. General information

NPI: 1255564563
Provider Name (Legal Business Name): SHAMILA G RAWAL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SHAMILA K GUPTA M.D.

II. Dates (important events)

Enumeration Date: 09/02/2009
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 SCIENCE CT STE 101
MADISON WI
53711-1090
US

IV. Provider business mailing address

2 SCIENCE CT STE 101
MADISON WI
53711-1090
US

V. Phone/Fax

Practice location:
  • Phone: 608-721-6132
  • Fax:
Mailing address:
  • Phone: 608-721-6132
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number36113795
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License Number69732
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: