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NPI Code Detail

MEDICARE: GAYATRI SATAM

MEDICARE:   GAYATRI  SATAM
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice Dentistry019.031755IL

General Provider Information

NPI Number : 1225514094
Entity Type Code : Individual
Provider Name (Legal Business Name) : GAYATRI SATAM
Provider Business Mailing Address
First Line : 6439 N ROCKWELL ST APT 2
Second Line :
City : CHICAGO
State : IL
Zip : 60645-5067
Country : US
Telephone Number : 773-885-0844
Fax Number :
Provider Business Practice Location Address
First Line : 4724 N KEDZIE AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60625-4421
Country : US
Telephone Number : 773-583-4455
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/16/2018
Last Update Date : 07/16/2018

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Directions to “ GAYATRI SATAM ” Practice Location

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