Provider Demographics
NPI:1598908675
Name:SINGH, GAURAV KUMAR (MD)
Entity Type:Individual
Prefix:
First Name:GAURAV
Middle Name:KUMAR
Last Name:SINGH
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 1:202 N HAMMES AVE UNIT A
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-8136
Mailing Address - Country:US
Mailing Address - Phone:815-744-2020
Mailing Address - Fax:815-729-4101
Practice Address - Street 1:202 N HAMMES AVE
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-8142
Practice Address - Country:US
Practice Address - Phone:815-744-2020
Practice Address - Fax:309-729-4100
Is Sole Proprietor?:No
Enumeration Date:2009-04-20
Last Update Date:2018-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-130222207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology