1427139690 NPI number — ABHILASHA GANJU MD

Table of content: (NPI 1164087334)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427139690 NPI number — ABHILASHA GANJU MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GANJU
Provider First Name:
ABHILASHA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GANJU
Provider Other First Name:
ABHI
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1427139690
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5600 WOLF RD
Provider Second Line Business Mailing Address:
#135
Provider Business Mailing Address City Name:
WESTERN SPRINGS
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60558-2254
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
708-246-4515
Provider Business Mailing Address Fax Number:
708-246-4502

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5600 WOLF RD
Provider Second Line Business Practice Location Address:
#135
Provider Business Practice Location Address City Name:
WESTERN SPRINGS
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60558-2254
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-246-4515
Provider Business Practice Location Address Fax Number:
708-246-4502
Provider Enumeration Date:
10/17/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207K00000X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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