Healthcare Provider Details

I. General information

NPI: 1952183238
Provider Name (Legal Business Name): GURPREET SINGH APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2023
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2917 W 95TH ST
EVERGREEN PARK IL
60805-2402
US

IV. Provider business mailing address

617 SLATE DR
WESTVILLE IN
46391-9685
US

V. Phone/Fax

Practice location:
  • Phone: 708-907-4355
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number209028490
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number71014526A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209028490
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: