Provider Demographics
NPI:1538461108
Name:GAVANI & KANURI MD SC
Entity Type:Organization
Organization Name:GAVANI & KANURI MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:UMA
Authorized Official - Middle Name:DEVI
Authorized Official - Last Name:GAVANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-636-9611
Mailing Address - Street 1:4400 W. 95TH STREET
Mailing Address - Street 2:SUITE 406
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453
Mailing Address - Country:US
Mailing Address - Phone:708-636-9611
Mailing Address - Fax:708-636-6577
Practice Address - Street 1:4400 W. 95TH STREET
Practice Address - Street 2:SUITE 406
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453
Practice Address - Country:US
Practice Address - Phone:708-636-9611
Practice Address - Fax:708-636-6577
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-02
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036051637207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILD14386Medicare UPIN
IL653001Medicare PIN