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NPI Code Detail

MEDICARE: MR. MANISH M SHUKLA MD

MEDICARE: MR. MANISH M SHUKLA 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
1207Q00000XFamily Medicine Physician036098634IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1619983558
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. MANISH M SHUKLA MD
Provider Business Mailing Address
First Line : 3943 W 31ST ST
Second Line :
City : CHICAGO
State : IL
Zip : 60623-4936
Country : US
Telephone Number : 773-523-8773
Fax Number : 773-523-9259
Provider Business Practice Location Address
First Line : 3943 W 31ST ST
Second Line : ST JUDE MEDICAL CENTER
City : CHICAGO
State : IL
Zip : 60623-4936
Country : US
Telephone Number : 773-523-8773
Fax Number : 773-523-9259
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/31/2006
Last Update Date : 01/31/2020

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