Healthcare Provider Details

I. General information

NPI: 1538574207
Provider Name (Legal Business Name): ANUGAYATHRI P GAYATHRI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANUGAYATHRI JAWAHAR MD

II. Dates (important events)

Enumeration Date: 06/21/2014
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

676 N SAINT CLAIR ST STE 800
CHICAGO IL
60611-2978
US

IV. Provider business mailing address

2160 S 1ST AVE
MAYWOOD IL
60153-3328
US

V. Phone/Fax

Practice location:
  • Phone: 312-695-5753
  • Fax: 312-695-5645
Mailing address:
  • Phone: 708-216-9000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberMT207532
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberA162668
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number036150590
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number162668
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number125-066128
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: