Provider Demographics
NPI:1710059027
Name:KATHPALIA, SHASHI B (MD)
Entity Type:Individual
Prefix:DR
First Name:SHASHI
Middle Name:B
Last Name:KATHPALIA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1051 ESSINGTON RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-2801
Mailing Address - Country:US
Mailing Address - Phone:815-726-1818
Mailing Address - Fax:
Practice Address - Street 1:1051 ESSINGTON RD
Practice Address - Street 2:SUITE 210
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-2801
Practice Address - Country:US
Practice Address - Phone:815-726-1818
Practice Address - Fax:815-726-0232
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2012-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036058832207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036058832Medicaid
IL09900582OtherBLUE CROSS BLUE SHIELD
IL110062817OtherMEDICARE RAILROAD
IL960500Medicare PIN
IL09900582OtherBLUE CROSS BLUE SHIELD