Provider Demographics
NPI:1982614657
Name:AHLUWALIA, SHAVINDER KAUR (MD)
Entity Type:Individual
Prefix:MRS
First Name:SHAVINDER
Middle Name:KAUR
Last Name:AHLUWALIA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SHAVINDER
Other - Middle Name:KAUR
Other - Last Name:WALIA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3006 SOUTH CAMPBELL ST
Mailing Address - Street 2:NORTH CENTRAL OHIO MEDICAL SERVICES INC
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44870
Mailing Address - Country:US
Mailing Address - Phone:419-625-7594
Mailing Address - Fax:419-626-5640
Practice Address - Street 1:3006 SOUTH CAMPBELL ST
Practice Address - Street 2:NORTH CENTRAL OHIO MEDICAL SERVICES INC
Practice Address - City:SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:44870
Practice Address - Country:US
Practice Address - Phone:419-625-7594
Practice Address - Fax:419-626-5640
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2010-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35053044208000000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0613036Medicaid
AH0601285Medicare ID - Type Unspecified
OH0613036Medicaid