Individual
MR. MANISH M SHUKLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3943 W 31ST ST, ST JUDE MEDICAL CENTER, CHICAGO, IL 60623-4936
(773) 523-8773
(773) 523-9259
Mailing address
3943 W 31ST ST, CHICAGO, IL 60623-4936
(773) 523-8773
(773) 523-9259
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036098634
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036098634
—
IL
Enumeration date
07/31/2006
Last updated
01/31/2020
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