Provider Demographics
NPI:1104855246
Name:SHELUB, IRWIN (MD)
Entity Type:Individual
Prefix:
First Name:IRWIN
Middle Name:
Last Name:SHELUB
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4975 IRON SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:CRESTON
Mailing Address - State:CA
Mailing Address - Zip Code:93432-9794
Mailing Address - Country:US
Mailing Address - Phone:650-520-0635
Mailing Address - Fax:
Practice Address - Street 1:4975 IRON SPRINGS RD
Practice Address - Street 2:
Practice Address - City:CRESTON
Practice Address - State:CA
Practice Address - Zip Code:93432-9794
Practice Address - Country:US
Practice Address - Phone:650-520-0635
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-01
Last Update Date:2017-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC36888207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA36397Medicare UPIN