Provider Demographics
NPI:1578826723
Name:JOHAL, GURBIR (MD)
Entity Type:Individual
Prefix:
First Name:GURBIR
Middle Name:
Last Name:JOHAL
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 1:4 HORSESHOE CT
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NJ
Mailing Address - Zip Code:08831-2368
Mailing Address - Country:US
Mailing Address - Phone:732-306-2879
Mailing Address - Fax:
Practice Address - Street 1:5840 S. MARYLAND AVE., MC4028,
Practice Address - Street 2:U OF CHICAGO, DEPT OF ANESTHESIA
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60637
Practice Address - Country:US
Practice Address - Phone:773-702-6700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-22
Last Update Date:2012-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125-060783207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology