Individual
DR. SHASHI B UPADHYA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
600 JOHN DEERE ROAD, SUITE 200, MOLINE, IL 61265-6897
(309) 779-4230
(309) 779-4305
Mailing address
600 JOHN DEERE ROAD, SUITE 200, MOLINE, IL 61265-6897
(309) 779-4230
(309) 779-4305
Taxonomy
Speciality
Code
Description
License number
State
207VG0400X
Gynecology Physician
Primary
036044906
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036044906
—
IL
01
—
L67355
MEDICARE PTAN
IL
Enumeration date
04/28/2006
Last updated
03/06/2009
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