Provider Demographics
NPI:1194252130
Name:HARI, SHILPA (MD)
Entity type:Individual
Prefix:
First Name:SHILPA
Middle Name:
Last Name:HARI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SILPHA SHILPA
Other - Middle Name:
Other - Last Name:HARI KUMAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1800 N KNOXVILLE AVE STE B
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61603-3005
Mailing Address - Country:US
Mailing Address - Phone:309-624-8517
Mailing Address - Fax:309-624-9694
Practice Address - Street 1:1800 N KNOXVILLE AVE STE B
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61603-3005
Practice Address - Country:US
Practice Address - Phone:309-624-8517
Practice Address - Fax:309-624-9694
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-22
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36.164133208000000X, 2080C0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080C0008XAllopathic & Osteopathic PhysiciansPediatricsChild Abuse Pediatrics
No208000000XAllopathic & Osteopathic PhysiciansPediatrics