Provider Demographics
NPI:1144290495
Name:SHANKARA, BESAGARAHALLY C (MD)
Entity type:Individual
Prefix:DR
First Name:BESAGARAHALLY
Middle Name:C
Last Name:SHANKARA
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 1:406 NORTH FRONT STREET
Mailing Address - Street 2:SUITE C
Mailing Address - City:MCHENRY
Mailing Address - State:IL
Mailing Address - Zip Code:60050
Mailing Address - Country:US
Mailing Address - Phone:815-344-6868
Mailing Address - Fax:815-344-5454
Practice Address - Street 1:406 FRONT ST
Practice Address - Street 2:SUITE C
Practice Address - City:MCHENRY
Practice Address - State:IL
Practice Address - Zip Code:60050-5593
Practice Address - Country:US
Practice Address - Phone:815-344-6868
Practice Address - Fax:815-344-5454
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-26
Last Update Date:2015-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036070042174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036070042Medicaid
ILC43021Medicare UPIN
IL732571Medicare ID - Type Unspecified