Healthcare Provider Details

I. General information

NPI: 1275582124
Provider Name (Legal Business Name): K.B.GIRI MDSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2006
Last Update Date: 08/22/2020
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 TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StateIL

VIII. Authorized Official

Name: DR. KUNDAN GIRI
Title or Position: PRESIDENT
Credential: M.D.
Phone: 708-450-9700