Provider Demographics
NPI:1255564563
Name:RAWAL, SHAMILA G (MD)
Entity type:Individual
Prefix:DR
First Name:SHAMILA
Middle Name:G
Last Name:RAWAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SHAMILA
Other - Middle Name:K
Other - Last Name:GUPTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:540 LAKE COOK RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:DEERFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60015-5289
Mailing Address - Country:US
Mailing Address - Phone:847-564-8500
Mailing Address - Fax:
Practice Address - Street 1:540 LAKE COOK RD
Practice Address - Street 2:SUITE 300
Practice Address - City:DEERFIELD
Practice Address - State:IL
Practice Address - Zip Code:60015-5289
Practice Address - Country:US
Practice Address - Phone:847-564-8500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-02
Last Update Date:2010-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36113795207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology