Healthcare Provider Details

I. General information

NPI: 1013012558
Provider Name (Legal Business Name): RANJIT SINGH WAHI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3522 E 95TH ST
CHICAGO IL
60617-5164
US

IV. Provider business mailing address

8 CASCADE CT W
BURR RIDGE IL
60527-0715
US

V. Phone/Fax

Practice location:
  • Phone: 773-933-0791
  • Fax: 773-933-4903
Mailing address:
  • Phone: 630-887-1483
  • Fax: 630-887-1483

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number036-76159
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: