Provider Demographics
NPI:1821246646
Name:ABHILASHA GANJU
Entity Type:Organization
Organization Name:ABHILASHA GANJU
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ABHILASHA
Authorized Official - Middle Name:
Authorized Official - Last Name:GANJU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-259-9360
Mailing Address - Street 1:1286 N MILWAUKEE AVE # 205
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60642-2219
Mailing Address - Country:US
Mailing Address - Phone:312-259-9360
Mailing Address - Fax:
Practice Address - Street 1:1286 N MILWAUKEE AVE # 205
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60642-2219
Practice Address - Country:US
Practice Address - Phone:312-259-9360
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-04
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036052756207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Multi-Specialty