Provider Demographics
NPI:1508942822
Name:GIRDHAR, KIRAN (MD)
Entity Type:Individual
Prefix:
First Name:KIRAN
Middle Name:
Last Name:GIRDHAR
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 1:333 CHESTNUT ST STE 203
Mailing Address - Street 2:
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-3249
Mailing Address - Country:US
Mailing Address - Phone:630-323-5522
Mailing Address - Fax:630-323-5524
Practice Address - Street 1:333 CHESTNUT ST STE 203
Practice Address - Street 2:
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-3249
Practice Address - Country:US
Practice Address - Phone:630-323-5522
Practice Address - Fax:630-323-5524
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-29
Last Update Date:2014-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036058101207K00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036058101Medicaid
IL787380Medicare ID - Type Unspecified
IL036058101Medicaid