1396801536 NPI number — SUKHJIT S GILL MDSC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396801536 NPI number — SUKHJIT S GILL MDSC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUKHJIT S GILL MDSC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1396801536
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/26/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
62 BAYBROOK LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OAK BROOK
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60523-1640
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
773-327-8008
Provider Business Mailing Address Fax Number:
773-327-0790

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2266 N LINCOLN AVE
Provider Second Line Business Practice Location Address:
THIRD FLOOR
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60614-3718
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-327-8008
Provider Business Practice Location Address Fax Number:
773-327-0790
Provider Enumeration Date:
12/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GILL
Authorized Official First Name:
SUKHJIT
Authorized Official Middle Name:
SINGH
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
773-327-8008

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , with the licence number:  036048281 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RI0011X , with the licence number: 036048281 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 036048281 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2201358 . This is a "BCBS" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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