=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285737866
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHASHI KUMAR MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/07/2006
-----------------------------------------------------
Last Update Date | 04/17/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7126 N LINCOLN AVE
-----------------------------------------------------
City | LINCOLNWOOD
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60712-2234
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-509-0023
-----------------------------------------------------
Fax | 773-825-8403
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7126 N LINCOLN AVE
-----------------------------------------------------
City | LINCOLNWOOD
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60712-2234
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-509-0023
-----------------------------------------------------
Fax | 773-825-8403
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | 036064050
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------