Basic Information
| Provider Information | |||||||||
| NPI: | 1922294388 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GOWDA | ||||||||
| FirstName: | NAYAN | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 120 W 22ND ST | ||||||||
| Address2: | NEPHROLOGY ASSOCIATES OF NORTHERN ILLINOIS | ||||||||
| City: | OAK BROOK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605231557 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6309745240 | ||||||||
| FaxNumber: | 6309745274 | ||||||||
| Practice Location | |||||||||
| Address1: | 2340 S HIGHLAND AVE STE 160 | ||||||||
| Address2: | |||||||||
| City: | LOMBARD | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60148 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6304959356 | ||||||||
| FaxNumber: | 6304953770 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/19/2007 | ||||||||
| LastUpdateDate: | 12/15/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/15/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RN0300X | 036128858 | IL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
ID Information
| ID | Type | State | Issuer | Description | 599673-01 | 05 | HI | MEDICAID | 036128858 | 05 | IL | MEDICAID | 0000269308 | 01 | HI | HMSA BILLING NUMBER | OTHER |