Provider Demographics
NPI:1003049966
Name:DHORAJIA, GIRISHKUMAR (MD)
Entity Type:Individual
Prefix:
First Name:GIRISHKUMAR
Middle Name:
Last Name:DHORAJIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1304 FRANKLIN AVE
Mailing Address - Street 2:ADVOCATE BROMENN MEDICAL CENTER
Mailing Address - City:NORMAL
Mailing Address - State:IL
Mailing Address - Zip Code:61761-3558
Mailing Address - Country:US
Mailing Address - Phone:423-439-2221
Mailing Address - Fax:
Practice Address - Street 1:1304 FRANKLIN AVE
Practice Address - Street 2:ADVOCATE BROMENN MEDICAL CENTER
Practice Address - City:NORMAL
Practice Address - State:IL
Practice Address - Zip Code:61761-3558
Practice Address - Country:US
Practice Address - Phone:309-268-5376
Practice Address - Fax:309-268-2374
Is Sole Proprietor?:No
Enumeration Date:2009-08-26
Last Update Date:2019-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.135221103TP0016X
IL0361352212084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)