Healthcare Provider Details

I. General information

NPI: 1669980033
Provider Name (Legal Business Name): HIREN GHAYAL PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2018
Last Update Date: 01/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5730 W ROOSEVELT RD
CHICAGO IL
60644-1580
US

IV. Provider business mailing address

1007 TWIN OAKS ST
BENSENVILLE IL
60106-1058
US

V. Phone/Fax

Practice location:
  • Phone: 773-413-1700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071009654
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: