Basic Information
| Provider Information | |||||||||
| NPI: | 1518328947 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GURLAKH PHYSICIANS SERVICES LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 165 N CANAL ST | ||||||||
| Address2: | 513 | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606061549 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6417510731 | ||||||||
| FaxNumber: | 7737512250 | ||||||||
| Practice Location | |||||||||
| Address1: | 165 N CANAL ST | ||||||||
| Address2: | 513 | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606061549 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6417510731 | ||||||||
| FaxNumber: | 7737512250 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/12/2016 | ||||||||
| LastUpdateDate: | 03/12/2016 | ||||||||
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| AuthorizedOfficialLastName: | RANDHAWA | ||||||||
| AuthorizedOfficialFirstName: | AMANDEEP | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | MBR | ||||||||
| AuthorizedOfficialTelephone: | 6417510731 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 036137608 | IL | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.