Provider Demographics
NPI:1467410183
Name:GAMBHIR MALKANI, MANJARI (MD)
Entity Type:Individual
Prefix:
First Name:MANJARI
Middle Name:
Last Name:GAMBHIR MALKANI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MANJARI
Other - Middle Name:
Other - Last Name:GAMBHIR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2357 SEQUOIA DR
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60506-6222
Mailing Address - Country:US
Mailing Address - Phone:630-859-6800
Mailing Address - Fax:
Practice Address - Street 1:1221 N HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60506-1404
Practice Address - Country:US
Practice Address - Phone:630-859-8700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01065017A207RR0500X
IL036109834207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036109834Medicaid
IN200916150Medicaid
ILI56411Medicare UPIN
IL0727500002Medicare NSC
INI56411Medicare UPIN
IN200916150Medicaid