Individual
MRS. SUDHA P SHAH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
6861 VILLAGREEN VW, ROCKFORD, IL 61107-5639
(815) 637-6200
Mailing address
PO BOX 1567, ROCKFORD, IL 61110-0067
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
036-069064
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036069064
—
IL
01
—
31792700
WISCONSIN MEDICAID
WI
Enumeration date
07/12/2005
Last updated
07/01/2015
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