Provider Demographics
NPI:1396034484
Name:KANSAL, NIDHI (MD)
Entity Type:Individual
Prefix:
First Name:NIDHI
Middle Name:
Last Name:KANSAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:259 E ERIE ST
Mailing Address - Street 2:SUITE 2230
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2987
Mailing Address - Country:US
Mailing Address - Phone:312-926-6000
Mailing Address - Fax:312-926-8267
Practice Address - Street 1:676 N ST CLAIR
Practice Address - Street 2:SUITE 2300
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2922
Practice Address - Country:US
Practice Address - Phone:312-926-6000
Practice Address - Fax:312-926-5971
Is Sole Proprietor?:No
Enumeration Date:2011-03-30
Last Update Date:2016-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125060483207R00000X
IL036135615207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF400160013Medicare PIN