Healthcare Provider Details

I. General information

NPI: 1245734854
Provider Name (Legal Business Name): KAPIL GURURANGAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2018
Last Update Date: 08/06/2025
Certification Date: 08/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

259 E ERIE ST STE 1900
CHICAGO IL
60611-3246
US

IV. Provider business mailing address

259 E ERIE ST STE 1900
CHICAGO IL
60611-3246
US

V. Phone/Fax

Practice location:
  • Phone: 312-695-7950
  • Fax: 312-695-5747
Mailing address:
  • Phone: 312-695-7950
  • Fax: 312-695-5747

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084E0001X
TaxonomyEpilepsy Physician
License Number036.171464
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code2084E0001X
TaxonomyEpilepsy Physician
License NumberA178652
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License Number036171464
License Number StateIL
# 4
Primary TaxonomyY
Taxonomy Code2084E0001X
TaxonomyEpilepsy Physician
License Number036171464
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: