MEDICARE: SHELLY AGARWAL MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	036127769	IL
2	207V00000X	Obstetrics & Gynecology Physician	MD-53756	IA
3	207VX0201X	Gynecologic Oncology Physician	125054706	IL

General Provider Information

NPI Number	:	1225284078
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHELLY AGARWAL MD

Provider Business Mailing Address
First Line	:	12251 S 80TH AVE
Second Line	:
City	:	PALOS HEIGHTS
State	:	IL
Zip	:	60463-1290
Country	:	US
Telephone Number	:	708-923-4000
Fax Number	:	708-923-4816

Provider Business Practice Location Address
First Line	:	12251 S 80TH AVE
Second Line	:
City	:	PALOS HEIGHTS
State	:	IL
Zip	:	60463-1290
Country	:	US
Telephone Number	:	708-923-4000
Fax Number	:	708-923-4816

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/12/2008
Last Update Date	:	12/04/2025

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Directions to “ SHELLY AGARWAL MD” Practice Location

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