Provider Demographics
NPI:1396859641
Name:GIRN, KAMALJEET S (MD)
Entity Type:Individual
Prefix:DR
First Name:KAMALJEET
Middle Name:S
Last Name:GIRN
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:PO BOX 1430
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:IN
Mailing Address - Zip Code:46368-9230
Mailing Address - Country:US
Mailing Address - Phone:219-763-8112
Mailing Address - Fax:219-764-6348
Practice Address - Street 1:800 E 55TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60615-4906
Practice Address - Country:US
Practice Address - Phone:773-702-0660
Practice Address - Fax:773-834-3756
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2018-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036112371207Q00000X
IN01059950A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200504050AMedicaid
IL036112371Medicaid
IN191360FMedicare ID - Type Unspecified