Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 125.070142 | IL |
Y | 111NI0900X | Internist | 125.070142 | IL |
NPI | 1003336660 |
---|---|
Provider Name | Gagandeep Singh Grover |
First Address | Mundelein, IL 60060-6014 |
Second Address | North Chicago, IL 60064-3048 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2017 |
Last Update Date | 26/06/2017 |