Individual
VIDYA SHANKARAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
340 W LINCOLN ST, STE 500, BELLEVILLE, IL 62220-1900
(618) 277-7400
Mailing address
340 W LINCOLN ST, STE 500, BELLEVILLE, IL 62220-1900
(618) 277-7400
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
Primary
036134925
IL
208200000X
Plastic Surgery Physician
20106
NH
208600000X
Surgery Physician
125050724
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
036134925
ILLINOIS DEPT OF FINANCIAL AND PROFESSIONAL REGULATION
IL
Enumeration date
08/08/2008
Last updated
11/22/2019
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