MEDICARE: GAGANDEEP KAUR M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	207Q00000X	Family Medicine Physician	01082137A	IN

General Provider Information

NPI Number	:	1033564422
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GAGANDEEP KAUR M.D.

Provider Business Mailing Address
First Line	:	100 W CHICAGO AVE STE F
Second Line	:
City	:	EAST CHICAGO
State	:	IN
Zip	:	46312-3261
Country	:	US
Telephone Number	:	219-703-2583
Fax Number	:	219-703-6749

Provider Business Practice Location Address
First Line	:	3432 169TH ST
Second Line	:
City	:	HAMMOND
State	:	IN
Zip	:	46323-2542
Country	:	US
Telephone Number	:	219-844-9060
Fax Number	:	219-844-6912

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/04/2016
Last Update Date	:	07/31/2019

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