Provider Demographics
NPI:1992041461
Name:ATWAL, GURSANT (MD)
Entity Type:Individual
Prefix:DR
First Name:GURSANT
Middle Name:
Last Name:ATWAL
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:UNIV. OF IL, DEPT. OF NEUROSURGERY
Mailing Address - Street 2:912 S WOOD ST, M/C 799, SUITE 451N
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-4434
Mailing Address - Country:US
Mailing Address - Phone:312-996-4842
Mailing Address - Fax:312-996-9018
Practice Address - Street 1:UNIVERSITY OF IL HOSPITAL & HEALTH SCIENCE SYSTEM
Practice Address - Street 2:1740 W TAYLOR ST
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612
Practice Address - Country:US
Practice Address - Phone:312-996-4842
Practice Address - Fax:312-996-9018
Is Sole Proprietor?:No
Enumeration Date:2013-01-02
Last Update Date:2018-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ50220207T00000X
390200000X
IL036145915207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ017023Medicaid
AZ017023Medicaid