Individual
SUJATA SHUKLA GUR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NURSE PRACTITIONER
Contact information
Practice address
2013 MIDWEST RD, OAK BROOK, IL 60523-1312
(630) 567-7851
Mailing address
2015 S FINLEY RD, #707, LOMBARD, IL 60148-4828
(630) 567-7851
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
209006824
IL
363LA2200X
Adult Health Nurse Practitioner
Primary
209006824
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
IL7391001
MEDICARE PTAN
IL
Enumeration date
11/23/2007
Last updated
02/09/2023
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