Healthcare Provider Details

I. General information

NPI: 1265481659
Provider Name (Legal Business Name): KUNDAN GIRI M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8319 W NORTH AVE
MELROSE PARK IL
60160-1605
US

IV. Provider business mailing address

8319 W NORTH AVE
MELROSE PARK IL
60160-1605
US

V. Phone/Fax

Practice location:
  • Phone: 708-450-9700
  • Fax: 708-450-9978
Mailing address:
  • Phone: 708-450-9700
  • Fax: 708-450-9978

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: