Healthcare Provider Details

I. General information

NPI: 1801536297
Provider Name (Legal Business Name): KESHAVA GALI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2022
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 SAINT MARYS RD
JUNCTION CITY KS
66441-4176
US

IV. Provider business mailing address

1426 ELGIN AVE APT 2
FOREST PARK IL
60130-2666
US

V. Phone/Fax

Practice location:
  • Phone: 785-762-2585
  • Fax: 785-238-5450
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number04-53620
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: