1447243258 NPI number — DR. MANOJ DUGGAL MD,FACC

Table of content: PAMELA CRAWFORD (NPI 1952727968)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447243258 NPI number — DR. MANOJ DUGGAL MD,FACC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DUGGAL
Provider First Name:
MANOJ
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD,FACC
Provider Gender Code:
M

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:
1447243258
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/16/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5009 W 95TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OAK LAWN
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60453-2401
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
708-636-7575
Provider Business Mailing Address Fax Number:
708-636-7193

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4400 W 95TH ST
Provider Second Line Business Practice Location Address:
SUITE 407
Provider Business Practice Location Address City Name:
OAK LAWN
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60453-2654
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-636-7575
Provider Business Practice Location Address Fax Number:
708-636-6193
Provider Enumeration Date:
08/26/2005

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: 207RC0001X , with the licence number:  036-085016 , 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)

  • Identifier: CI8250 . This is a "PALMETTO GBA GROUP #" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 21622931 . This is a "BCBS GROUP #" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 036085016 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 060053840 . This is a "PALMETTO GBA INDIVIDUAL #" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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