Provider Demographics
NPI:1073868485
Name:SHUKLA CLINICAL, LLC
Entity Type:Organization
Organization Name:SHUKLA CLINICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:SUJATA
Authorized Official - Middle Name:SHUKLA
Authorized Official - Last Name:GUR
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, APN/CNP
Authorized Official - Phone:630-495-0220
Mailing Address - Street 1:2013 MIDWEST RD
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1312
Mailing Address - Country:US
Mailing Address - Phone:630-495-0220
Mailing Address - Fax:
Practice Address - Street 1:2013 MIDWEST RD
Practice Address - Street 2:
Practice Address - City:OAK BROOK
Practice Address - State:IL
Practice Address - Zip Code:60523-1312
Practice Address - Country:US
Practice Address - Phone:630-495-0220
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-23
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041.316119174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty