MEDICARE: KANWARJIT GILL

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	247100000X	Radiologic Technologist	230469	IL

General Provider Information

NPI Number	:	1609227206
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KANWARJIT GILL

Provider Business Mailing Address
First Line	:	8207 LAKE ST
Second Line	:
City	:	RIVER FOREST
State	:	IL
Zip	:	60305-1619
Country	:	US
Telephone Number	:	708-704-4551
Fax Number	:

Provider Business Practice Location Address
First Line	:	8207 LAKE ST
Second Line	:
City	:	RIVER FOREST
State	:	IL
Zip	:	60305-1619
Country	:	US
Telephone Number	:	708-704-4551
Fax Number	:

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

Provider Enumeration Date	:	06/24/2016
Last Update Date	:	06/24/2016

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Directions to “ KANWARJIT GILL ” Practice Location

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