Healthcare Provider Details

I. General information

NPI: 1508444944
Provider Name (Legal Business Name): SHIVANGI GOHIL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2021
Last Update Date: 07/10/2024
Certification Date: 07/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 S PAULINA ST
CHICAGO IL
60612-3806
US

IV. Provider business mailing address

600 S PAULINA ST
CHICAGO IL
60612-3806
US

V. Phone/Fax

Practice location:
  • Phone: 312-942-5495
  • Fax: 312-942-5727
Mailing address:
  • Phone: 312-942-5495
  • Fax: 312-942-5727

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number94-10806
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number036170892
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: