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General NPI Number Information
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NPI Number | 1538059589
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Entity Type | Individual
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Provider Name | AGNIMSHWOR DAHAL
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Gender | Male
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Dates
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Enumeration Date | 07/09/2025
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Last Update Date | 07/09/2025
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Provider Practice Location Address
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Address Line | 1969 W OGDEN AVE
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City | CHICAGO
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State | IL
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Zip | 60612-3765
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Country | US
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Telephone | 312-864-6000
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Fax |
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Provider Business Mailing Address
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Address Line | 903 S ASHLAND AVE APT 713
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City | CHICAGO
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State | IL
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Zip | 60607-4187
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Country | US
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Telephone | 312-375-6795
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 125.085202
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License Number State | IL
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