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General NPI Number Information
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NPI Number | 1568667376
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Entity Type | Organization
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Legal Business Name | GANESH MEDICAL SC
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Dates
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Enumeration Date | 06/20/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 214 CHAUCER CT
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City | WILLOWBROOK
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State | IL
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Zip | 60527-5407
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Country | US
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Telephone | 312-622-6314
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Fax | 708-488-8073
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Provider Business Mailing Address
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Address Line | 214 CHAUCER CT
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City | WILLOWBROOK
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State | IL
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Zip | 60527-5407
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Country | US
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Telephone | 312-622-6314
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Fax | 708-488-8073
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Authorized Official
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Title or Position | FAMILY PHYSICIAN
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Name | DR. CHIRAG PATEL
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Credential | D.O.
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Telephone | 312-622-6314
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State | IL
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