Provider Demographics
NPI:1184781338
Name:VISHNU D GAIHA MD SC
Entity type:Organization
Organization Name:VISHNU D GAIHA MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VISHNU
Authorized Official - Middle Name:DAS
Authorized Official - Last Name:GAIHA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-491-1977
Mailing Address - Street 1:800 AUSTIN ST
Mailing Address - Street 2:WEST TOWER SUITE 602
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60202-3439
Mailing Address - Country:US
Mailing Address - Phone:847-491-1977
Mailing Address - Fax:847-491-0949
Practice Address - Street 1:800 AUSTIN ST
Practice Address - Street 2:WEST TOWER SUITE 602
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60202-3439
Practice Address - Country:US
Practice Address - Phone:847-491-1977
Practice Address - Fax:847-491-0949
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36046908174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILC38571Medicare UPIN
IL475120Medicare ID - Type Unspecified