MEDICARE: GURLAKH PHYSICIANS SERVICES LLC

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	036137608	IL

General Provider Information

NPI Number	:	1518328947
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GURLAKH PHYSICIANS SERVICES LLC

Provider Business Mailing Address
First Line	:	165 N CANAL ST
Second Line	:	513
City	:	CHICAGO
State	:	IL
Zip	:	60606-1549
Country	:	US
Telephone Number	:	641-751-0731
Fax Number	:	773-751-2250

Provider Business Practice Location Address
First Line	:	165 N CANAL ST
Second Line	:	513
City	:	CHICAGO
State	:	IL
Zip	:	60606-1549
Country	:	US
Telephone Number	:	641-751-0731
Fax Number	:	773-751-2250

Authorized Official
Title or Position	:	MBR
Name	:	DR. AMANDEEP S RANDHAWA
Credential	:	MD
Telephone Number	:	641-751-0731

Provider Enumeration Date	:	03/12/2016
Last Update Date	:	03/12/2016

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