Healthcare Provider Details

I. General information

NPI: 1659865558
Provider Name (Legal Business Name): NAIOMI GUNARATNE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2018
Last Update Date: 10/06/2024
Certification Date: 10/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 E CHICAGO AVE # 54
CHICAGO IL
60611-2991
US

IV. Provider business mailing address

225 E CHICAGO AVE # 54
CHICAGO IL
60611-2991
US

V. Phone/Fax

Practice location:
  • Phone: 773-227-6090
  • Fax:
Mailing address:
  • Phone: 312-227-6090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036.155974
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: