Healthcare Provider Details

I. General information

NPI: 1164088100
Provider Name (Legal Business Name): GURPREET K KHAIRA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2019
Last Update Date: 01/09/2020
Certification Date: 01/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 EAST CHICAGO AVENUE ANN & ROBERT H. LURIE CHILDREN'
CHICAGO IL
60611
US

IV. Provider business mailing address

11168 83 AVE NW
EDMONTON ALBERTA
T6G 0V1
CA

V. Phone/Fax

Practice location:
  • Phone: 312-227-4000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: