Provider Demographics
NPI:1114115060
Name:SHOBHA S IYENGAR, MD SC
Entity Type:Organization
Organization Name:SHOBHA S IYENGAR, MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:SHOBHA
Authorized Official - Middle Name:S
Authorized Official - Last Name:IYENGAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:815-547-5007
Mailing Address - Street 1:1371 SANDHURST LN
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61107-2789
Mailing Address - Country:US
Mailing Address - Phone:815-547-5007
Mailing Address - Fax:
Practice Address - Street 1:2186 UNIT 1
Practice Address - Street 2:NORTH STATE STREET
Practice Address - City:BELVIDERE
Practice Address - State:IL
Practice Address - Zip Code:61008-3918
Practice Address - Country:US
Practice Address - Phone:815-547-5007
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-04
Last Update Date:2011-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty