1992041461 NPI number — DR. GURSANT ATWAL M.D.

Table of content: DR. GURSANT ATWAL M.D. (NPI 1992041461)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992041461 NPI number — DR. GURSANT ATWAL M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ATWAL
Provider First Name:
GURSANT
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1992041461
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/11/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
UNIV. OF IL, DEPT. OF NEUROSURGERY
Provider Second Line Business Mailing Address:
912 S WOOD ST, M/C 799, SUITE 451N
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60612-4434
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
312-996-4842
Provider Business Mailing Address Fax Number:
312-996-9018

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
UNIVERSITY OF IL HOSPITAL & HEALTH SCIENCE SYSTEM
Provider Second Line Business Practice Location Address:
1740 W TAYLOR ST
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60612
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
312-996-4842
Provider Business Practice Location Address Fax Number:
312-996-9018
Provider Enumeration Date:
01/02/2013

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: 207T00000X , with the licence number:  50220 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207T00000X , with the licence number: 036145915 , 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: 017023 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com