MEDICARE: K.B.GIRI MDSC

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	208000000X	Pediatrics Physician		IL
2	208000000X	Pediatrics Physician		IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	02201118	OTHER	IL	BCBS
2	2066533	OTHER	IL	CIGNA

General Provider Information

NPI Number	:	1275582124
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	K.B.GIRI MDSC

Provider Business Mailing Address
First Line	:	8319 W NORTH AVE
Second Line	:
City	:	MELROSE PARK
State	:	IL
Zip	:	60160-1605
Country	:	US
Telephone Number	:	708-450-9700
Fax Number	:	708-450-9978

Provider Business Practice Location Address
First Line	:	8319 W NORTH AVE
Second Line	:
City	:	MELROSE PARK
State	:	IL
Zip	:	60160-1605
Country	:	US
Telephone Number	:	708-450-9700
Fax Number	:	708-450-9978

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. KUNDAN GIRI
Credential	:	M.D.
Telephone Number	:	708-450-9700

Provider Enumeration Date	:	05/09/2006
Last Update Date	:	08/22/2020

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