Provider Demographics
NPI:1457410094
Name:KGO GI INC
Entity Type:Organization
Organization Name:KGO GI INC
Other - Org Name:KGO-GI, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:RN MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:GHAZANFARI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-871-4600
Mailing Address - Street 1:3004 N ASHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-3012
Mailing Address - Country:US
Mailing Address - Phone:773-871-4600
Mailing Address - Fax:
Practice Address - Street 1:3004 N ASHLAND AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-3012
Practice Address - Country:US
Practice Address - Phone:773-871-4600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0800XAmbulatory Health Care FacilitiesClinic/CenterEndoscopy