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General NPI Number Information
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NPI Number | 1568878221
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Entity Type | Organization
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Legal Business Name | TEJASI GHOLAP MD SC
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Dates
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Enumeration Date | 07/02/2014
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Last Update Date | 07/02/2014
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Provider Practice Location Address
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Address Line | 901 CENTER ST SUITE 209
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City | ELGIN
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State | IL
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Zip | 60120-2104
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Country | US
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Telephone | 847-429-1157
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Fax |
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Provider Business Mailing Address
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Address Line | 2350 COUNTY FARM LN
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City | SCHAUMBURG
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State | IL
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Zip | 60194-4807
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Country | US
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Telephone | 414-736-7583
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TEJASI GHOLAP
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Credential | MD
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Telephone | 414-736-7583
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 036125306
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License Number State | IL
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