Provider Demographics
NPI:1992901185
Name:SHANKAR, UDAY R (MD)
Entity type:Individual
Prefix:
First Name:UDAY
Middle Name:R
Last Name:SHANKAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:UDAYA
Other - Middle Name:S
Other - Last Name:RANGAPPA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:611 W. PARK ST.
Mailing Address - Street 2:BWPC
Mailing Address - City:URBANA
Mailing Address - State:IL
Mailing Address - Zip Code:61801-2500
Mailing Address - Country:US
Mailing Address - Phone:217-383-6792
Mailing Address - Fax:
Practice Address - Street 1:611 W. PARK ST.
Practice Address - Street 2:
Practice Address - City:URBANA
Practice Address - State:IL
Practice Address - Zip Code:61801-2500
Practice Address - Country:US
Practice Address - Phone:217-383-3129
Practice Address - Fax:217-326-1550
Is Sole Proprietor?:No
Enumeration Date:2007-06-25
Last Update Date:2015-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301089397207R00000X
IL036124883208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1992901185Medicaid
IL3932056OtherBCBS
IL721089OtherAETNA
MI1992901185Medicaid
IL214881Medicare Oscar/Certification
IL208905185Medicare PIN