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NPI Code Detail

MEDICARE: JYOTI GUR MD

MEDICARE: JYOTI GUR MD
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
1208000000XPediatrics Physician036-174060IL
2208000000XPediatrics Physician84000CT

General Provider Information

NPI Number : 1578084398
Entity Type Code : Individual
Provider Name (Legal Business Name) : JYOTI GUR MD
Provider Business Mailing Address
First Line : 4341 44TH ST APT 2F
Second Line :
City : SUNNYSIDE
State : NY
Zip : 11104-4613
Country : US
Telephone Number : 781-975-9519
Fax Number :
Provider Business Practice Location Address
First Line : 4440 W 95TH ST
Second Line :
City : OAK LAWN
State : IL
Zip : 60453-2600
Country : US
Telephone Number : 708-684-5580
Fax Number : 708-684-4068
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/01/2017
Last Update Date : 04/06/2026

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