Provider Demographics
NPI:1588715619
Name:SHUKLA, AMUL V (MD)
Entity type:Individual
Prefix:DR
First Name:AMUL
Middle Name:V
Last Name:SHUKLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18880 STATE RT 136
Mailing Address - Street 2:P.O. BOX 275
Mailing Address - City:WINCHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45697
Mailing Address - Country:US
Mailing Address - Phone:937-695-0972
Mailing Address - Fax:
Practice Address - Street 1:18880 STATE RT 136
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:OH
Practice Address - Zip Code:45697
Practice Address - Country:US
Practice Address - Phone:937-695-0972
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2010-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35 04 6463 S207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHCO2156Medicare UPIN
OHSH0501651Medicare ID - Type Unspecified