Provider Demographics
NPI:1255565990
Name:GAMBHIR, PRIYA (MD)
Entity type:Individual
Prefix:DR
First Name:PRIYA
Middle Name:
Last Name:GAMBHIR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:680 N LAKE SHORE DR STE 1000
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-8709
Mailing Address - Country:US
Mailing Address - Phone:312-695-9797
Mailing Address - Fax:847-535-8210
Practice Address - Street 1:870 N MILWAUKEE AVE
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:VERNON HILLS
Practice Address - State:IL
Practice Address - Zip Code:60061-1521
Practice Address - Country:US
Practice Address - Phone:847-926-0106
Practice Address - Fax:847-535-8210
Is Sole Proprietor?:No
Enumeration Date:2009-05-10
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036121954207Q00000X
WI54207-020207Q00000X
CAA114049207Q00000X
NJ25MA09568100207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL7009Medicare PIN
ILIL7010Medicare PIN