Provider Demographics
NPI:1033384961
Name:HERLIHY, GURVINDER S (PAC)
Entity Type:Individual
Prefix:
First Name:GURVINDER
Middle Name:S
Last Name:HERLIHY
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 E ARMY TRAIL RD STE 403
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60108-2155
Mailing Address - Country:US
Mailing Address - Phone:630-894-7083
Mailing Address - Fax:630-894-9472
Practice Address - Street 1:303 E ARMY TRAIL RD STE 403
Practice Address - Street 2:
Practice Address - City:BLOOMINGDALE
Practice Address - State:IL
Practice Address - Zip Code:60108-2155
Practice Address - Country:US
Practice Address - Phone:630-894-7083
Practice Address - Fax:630-894-9472
Is Sole Proprietor?:No
Enumeration Date:2008-04-22
Last Update Date:2016-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL85-002870363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL85-002870OtherSTATE OF ILLINOIS