Provider Demographics
NPI:1871671271
Name:SHASTRI, NIKHIL J (MD)
Entity Type:Individual
Prefix:DR
First Name:NIKHIL
Middle Name:J
Last Name:SHASTRI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 S MICHIGAN AVE APT 1203
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60605-3720
Mailing Address - Country:US
Mailing Address - Phone:312-767-3244
Mailing Address - Fax:
Practice Address - Street 1:900 RAND RD STE 120
Practice Address - Street 2:
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60016-2359
Practice Address - Country:US
Practice Address - Phone:312-767-3244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01092945A207RG0100X
IL036136083207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI35287100Medicaid
WI1871671271Medicaid