Provider Demographics
NPI:1598745275
Name:PAREKH, SHRUTI P (PA)
Entity Type:Individual
Prefix:
First Name:SHRUTI
Middle Name:P
Last Name:PAREKH
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:SHRUTI
Other - Middle Name:P
Other - Last Name:GANDHI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:2357 SEQUOIA DR
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60506-6222
Mailing Address - Country:US
Mailing Address - Phone:630-859-6800
Mailing Address - Fax:
Practice Address - Street 1:1221 N HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60506-1404
Practice Address - Country:US
Practice Address - Phone:630-859-8700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1866-023363A00000X
IL085002354363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL04515143OtherBS PROVIDER#
ILK52346Medicare PIN
IL0727500001Medicare NSC
ILK52347Medicare PIN
IL04515143OtherBS PROVIDER#