Individual
SHUBHRAJAN S WADYAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1786 MOON LAKE BLVD, SUITE 104, HOFFMAN ESTATES, IL 60169-5029
(847) 755-8090
(847) 843-7393
Mailing address
1786 MOON LAKE BLVD, SUITE 104, HOFFMAN ESTATES, IL 60169-5029
(847) 755-8090
(847) 843-7393
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
036-135143
IL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
50986
—
LA
Enumeration date
05/16/2008
Last updated
07/14/2014
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