Provider Demographics
NPI:1942221981
Name:LALMALANI, GOPAL (MD)
Entity Type:Individual
Prefix:
First Name:GOPAL
Middle Name:
Last Name:LALMALANI
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 1:777 OAKMONT LN
Mailing Address - Street 2:SUITE 1600
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-5511
Mailing Address - Country:US
Mailing Address - Phone:630-789-2550
Mailing Address - Fax:
Practice Address - Street 1:2340 S HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-5371
Practice Address - Country:US
Practice Address - Phone:630-792-0900
Practice Address - Fax:630-792-0966
Is Sole Proprietor?:No
Enumeration Date:2006-07-23
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036050305207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL36365711702OtherADVOCATE HLTH CENTERS ID
IL36365711726251OtherADVOCATE HLTH PARTNERS ID
IL01618378OtherBCBS PROVIDER ID
IL060009557OtherRAILROAD MEDICARE
IL036050305Medicaid
IL060018893OtherRAILROAD MEDICARE
IL060009557OtherRAILROAD MEDICARE
ILL10203Medicare PIN
IL036050305Medicaid