Provider Demographics
NPI:1669211843
Name:GONDAL, FAISAL JAMIL (MD)
Entity type:Individual
Prefix:DR
First Name:FAISAL
Middle Name:JAMIL
Last Name:GONDAL
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 1:2475 LEHMAN DR
Mailing Address - Street 2:
Mailing Address - City:WEST CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60185-6178
Mailing Address - Country:US
Mailing Address - Phone:954-504-2849
Mailing Address - Fax:
Practice Address - Street 1:96 15TH ST. NE,
Practice Address - Street 2:SUITE 104,
Practice Address - City:NORTON
Practice Address - State:VA
Practice Address - Zip Code:24273
Practice Address - Country:US
Practice Address - Phone:276-679-7457
Practice Address - Fax:276-439-1872
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-20
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0116038958390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program