Provider Demographics
NPI:1669634770
Name:FADIA, SHRUTI A (MD)
Entity type:Individual
Prefix:DR
First Name:SHRUTI
Middle Name:A
Last Name:FADIA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29373 NETWORK PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60673-1293
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2001 N GARY AVE STE 240
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-3055
Practice Address - Country:US
Practice Address - Phone:630-416-4501
Practice Address - Fax:630-416-4504
Is Sole Proprietor?:No
Enumeration Date:2008-06-30
Last Update Date:2025-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT192950208000000X
IN01074405A2080P0205X, 208000000X
IL0361395922080P0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric Endocrinology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201247820Medicaid
IN201247820Medicaid