Individual
OHM SHUKLA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
EMT-B
Contact information
Practice address
11 GERTY DR, CHAMPAIGN, IL 61820-7404
(217) 338-8925
Mailing address
11 GERTY DR, CHAMPAIGN, IL 61820-7404
Taxonomy
Speciality
Code
Description
License number
State
146N00000X
Basic Emergency Medical Technician
Primary
060678431
IL
Other
Enumeration date
06/29/2022
Last updated
06/29/2022
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