MEDICARE: DR. PRIYA GAMBHIR 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	207Q00000X	Family Medicine Physician	036121954	IL
2	207Q00000X	Family Medicine Physician	54207-020	WI
3	207Q00000X	Family Medicine Physician	A114049	CA
4	207Q00000X	Family Medicine Physician	25MA09568100	NJ

General Provider Information

NPI Number	:	1255565990
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PRIYA GAMBHIR M.D.

Provider Business Mailing Address
First Line	:	680 N LAKE SHORE DR STE 1000
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60611-8709
Country	:	US
Telephone Number	:	312-695-9797
Fax Number	:	847-535-8210

Provider Business Practice Location Address
First Line	:	870 N MILWAUKEE AVE
Second Line	:	SECOND FLOOR
City	:	VERNON HILLS
State	:	IL
Zip	:	60061-1521
Country	:	US
Telephone Number	:	847-926-0106
Fax Number	:	847-535-8210

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

Provider Enumeration Date	:	05/10/2009
Last Update Date	:	12/05/2016

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