Provider Demographics
NPI:1467517755
Name:NANDRA, GURIQBAL SINGH (MD)
Entity Type:Individual
Prefix:DR
First Name:GURIQBAL
Middle Name:SINGH
Last Name:NANDRA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:195 N. HARBOR DR.
Mailing Address - Street 2:SUITE #3302
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60601
Mailing Address - Country:US
Mailing Address - Phone:312-540-0130
Mailing Address - Fax:312-540-6733
Practice Address - Street 1:645 S CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60644-5059
Practice Address - Country:US
Practice Address - Phone:773-626-4300
Practice Address - Fax:773-626-3732
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-097928207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01638884OtherBLUE CROSS BLUE SHIELD
IL036097928Medicaid
IL036097928Medicaid
ILG93394Medicare UPIN