Provider Demographics
NPI:1922294388
Name:GOWDA, NAYAN S (MD)
Entity Type:Individual
Prefix:
First Name:NAYAN
Middle Name:S
Last Name:GOWDA
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 1:120 W 22ND ST STE 200
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1563
Mailing Address - Country:US
Mailing Address - Phone:630-573-5000
Mailing Address - Fax:
Practice Address - Street 1:2340 S HIGHLAND AVE STE 160
Practice Address - Street 2:
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148
Practice Address - Country:US
Practice Address - Phone:630-495-9356
Practice Address - Fax:630-495-3770
Is Sole Proprietor?:No
Enumeration Date:2007-09-19
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036128858207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036128858Medicaid
HI599673-01Medicaid
HI0000269308OtherHMSA BILLING NUMBER
HI599673-01Medicaid
IL922820016Medicare PIN
HI0000269308OtherHMSA BILLING NUMBER