Provider Demographics
NPI:1366015075
Name:SIGDEL, SHUSHIL (MD)
Entity Type:Individual
Prefix:
First Name:SHUSHIL
Middle Name:
Last Name:SIGDEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7411 LAKE ST
Mailing Address - Street 2:STE 1120
Mailing Address - City:RIVER FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60305-1882
Mailing Address - Country:US
Mailing Address - Phone:708-783-2328
Mailing Address - Fax:708-345-9984
Practice Address - Street 1:4646 N MARINE DR
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-5759
Practice Address - Country:US
Practice Address - Phone:773-564-5225
Practice Address - Fax:773-564-5226
Is Sole Proprietor?:No
Enumeration Date:2021-07-20
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL125.077306207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine