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NPI Code Detail

MEDICARE: MADHU GOPAL MD

MEDICARE: MADHU GOPAL MD
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
1207Q00000XFamily Medicine Physician036-094944IL

General Provider Information

NPI Number : 1891878120
Entity Type Code : Individual
Provider Name (Legal Business Name) : MADHU GOPAL MD
Provider Business Mailing Address
First Line : 845 W WILSON AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60640-5704
Country : US
Telephone Number : 773-506-4283
Fax Number : 773-506-4847
Provider Business Practice Location Address
First Line : 845 W WILSON AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60640-5704
Country : US
Telephone Number : 773-506-4283
Fax Number : 773-506-4847
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/23/2006
Last Update Date : 04/25/2013

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Directions to “ MADHU GOPAL MD” Practice Location

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