Basic Information
| Provider Information | |||||||||
| NPI: | 1053342428 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KAMBOJ | ||||||||
| FirstName: | GINNY | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 661 RIDGEVIEW DR | ||||||||
| Address2: | |||||||||
| City: | MCHENRY | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600507012 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8153078075 | ||||||||
| FaxNumber: | 8153444302 | ||||||||
| Practice Location | |||||||||
| Address1: | 661 RIDGEVIEW DR | ||||||||
| Address2: | |||||||||
| City: | MCHENRY | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600507012 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8153078075 | ||||||||
| FaxNumber: | 8153444302 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/05/2006 | ||||||||
| LastUpdateDate: | 02/11/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 02/11/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0000X | 036102484 | IL | N | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology | 207RX0202X | 036102484 | IL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Medical Oncology |
No ID Information.