Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0205X | Pediatric Endocrinologist | IL |
NPI | 1366519415 |
---|---|
Provider Name | Kanika Ghai |
First Address | Burr Ridge, IL 60527-0300 |
Second Address | Park Ridge, IL 60068-1143 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G802621 | (02) | IL |