Provider Demographics
NPI:1609940972
Name:GIREESAN, GIRI T (MD)
Entity Type:Individual
Prefix:
First Name:GIRI
Middle Name:T
Last Name:GIREESAN
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 1:676 NORTH ST CLAIR ST
Mailing Address - Street 2:#1777
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611
Mailing Address - Country:US
Mailing Address - Phone:312-787-7463
Mailing Address - Fax:312-787-5835
Practice Address - Street 1:676 NORTH ST CLAIR ST
Practice Address - Street 2:#1777
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611
Practice Address - Country:US
Practice Address - Phone:312-787-7463
Practice Address - Fax:312-787-5835
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2012-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL363656098207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILE21091Medicare UPIN