Healthcare Provider Details

I. General information

NPI: 1124314349
Provider Name (Legal Business Name): GAURANG GUJARATHI DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2011
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13011 S 104TH AVE STE 100
PALOS PARK IL
60464-1508
US

IV. Provider business mailing address

13011 S 104TH AVE STE 100
PALOS PARK IL
60464-1508
US

V. Phone/Fax

Practice location:
  • Phone: 708-478-4224
  • Fax: 708-274-3299
Mailing address:
  • Phone: 708-478-3600
  • Fax: 708-390-2130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number036133707
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: