Provider Demographics
NPI:1508283573
Name:GOMBERAWALLA, INSIYAH AAMIR (MD)
Entity type:Individual
Prefix:DR
First Name:INSIYAH
Middle Name:AAMIR
Last Name:GOMBERAWALLA
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:INSIYAH
Other - Middle Name:
Other - Last Name:NOMANBHOY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12716 S MISTY HARBOUR LN
Mailing Address - Street 2:
Mailing Address - City:PALOS PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60464-2570
Mailing Address - Country:US
Mailing Address - Phone:408-507-7861
Mailing Address - Fax:
Practice Address - Street 1:12716 S MISTY HARBOUR LN
Practice Address - Street 2:
Practice Address - City:PALOS PARK
Practice Address - State:IL
Practice Address - Zip Code:60464-2570
Practice Address - Country:US
Practice Address - Phone:408-507-7861
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-27
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125.064759208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics