Healthcare Provider Details

I. General information

NPI: 1578084398
Provider Name (Legal Business Name): JYOTI GUR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2017
Last Update Date: 04/06/2026
Certification Date: 04/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4440 W 95TH ST
OAK LAWN IL
60453-2600
US

IV. Provider business mailing address

4341 44TH ST APT 2F
SUNNYSIDE NY
11104-4613
US

V. Phone/Fax

Practice location:
  • Phone: 708-684-5580
  • Fax: 708-684-4068
Mailing address:
  • Phone: 781-975-9519
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036-174060
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number84000
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: