Healthcare Provider Details

I. General information

NPI: 1356286835
Provider Name (Legal Business Name): KTAG HEALTH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2026
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 E SAINT CHARLES RD
VILLA PARK IL
60181-2411
US

IV. Provider business mailing address

6549 GARFIELD AVE
BURR RIDGE IL
60527-5238
US

V. Phone/Fax

Practice location:
  • Phone: 312-898-2671
  • Fax:
Mailing address:
  • Phone: 312-898-2671
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. MANISH GORASIYA
Title or Position: PARTNER
Credential: MD, MPH
Phone: 551-208-6516