MEDICARE: JAGAN K KANSAL 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	208800000X	Urology Physician	036-153180	IL
2	208800000X	Urology Physician	01097404A	IN
3	208800000X	Urology Physician	70572	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1942611694
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAGAN K KANSAL M.D

Provider Business Mailing Address
First Line	:	20706 CARDINAL CT
Second Line	:
City	:	FRANKFORT
State	:	IL
Zip	:	60423-3106
Country	:	US
Telephone Number	:	312-620-1803
Fax Number	:

Provider Business Practice Location Address
First Line	:	1030 N CLARK ST STE 310
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60610-5413
Country	:	US
Telephone Number	:	312-620-1803
Fax Number	:

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

Provider Enumeration Date	:	05/15/2014
Last Update Date	:	12/16/2025

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