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General NPI Number Information
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NPI Number | 1003049966
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Entity Type | Individual
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Provider Name | GIRISHKUMAR DHORAJIA MD
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Gender | Male
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Dates
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Enumeration Date | 08/26/2009
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Last Update Date | 08/28/2019
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Provider Practice Location Address
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Address Line | 1304 FRANKLIN AVE ADVOCATE BROMENN MEDICAL CENTER
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City | NORMAL
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State | IL
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Zip | 61761-3558
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Country | US
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Telephone | 309-268-5376
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Fax | 309-268-2374
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Provider Business Mailing Address
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Address Line | 1304 FRANKLIN AVE ADVOCATE BROMENN MEDICAL CENTER
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City | NORMAL
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State | IL
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Zip | 61761-3558
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Country | US
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Telephone | 423-439-2221
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TP0016X
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Taxonomy Name | Prescribing (Medical) Psychologist
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License Number | 036.135221
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 036135221
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License Number State | IL
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