Provider Demographics
NPI:1689666992
Name:LODD, SHUBHANGI (MD)
Entity Type:Individual
Prefix:DR
First Name:SHUBHANGI
Middle Name:
Last Name:LODD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SHUBHANGI
Other - Middle Name:
Other - Last Name:CHAUDHARI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:150 W HALF DAY RD
Mailing Address - Street 2:SUITE 314
Mailing Address - City:BUFFALO GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60089-6591
Mailing Address - Country:US
Mailing Address - Phone:847-883-0999
Mailing Address - Fax:847-883-0990
Practice Address - Street 1:150 W HALF DAY RD
Practice Address - Street 2:SUITE NUMBER 206
Practice Address - City:BUFFALO GROVE
Practice Address - State:IL
Practice Address - Zip Code:60089-6591
Practice Address - Country:US
Practice Address - Phone:630-776-8832
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-22
Last Update Date:2010-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL336069222207Q00000X
WI45553020207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIH80844Medicare UPIN
WI006502690Medicare ID - Type Unspecified