Basic Information
| Provider Information | |||||||||
| NPI: | 1376035105 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ARORA | ||||||||
| FirstName: | SHANNON | ||||||||
| MiddleName: | |||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 CLINIC DR | ||||||||
| Address2: | |||||||||
| City: | MADISONVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 424311661 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2708257200 | ||||||||
| FaxNumber: | 2708257266 | ||||||||
| Practice Location | |||||||||
| Address1: | 200 CLINIC DR | ||||||||
| Address2: | |||||||||
| City: | MADISONVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 424311661 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2708257200 | ||||||||
| FaxNumber: | 2708257266 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/06/2018 | ||||||||
| LastUpdateDate: | 08/31/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/31/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 036.159768 | IL | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 53785 | KY | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | MD26097 | ME | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | EMC0001876 | MI | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 22953 | NH | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 66079 | TN | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 1956-320 | WI | N | Allopathic & Osteopathic Physicians | Family Medicine | 390200000X | N | 193200000X MULTI-SPECIALTY GROUP | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207Q00000X | 30526 | WV | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.