Provider Demographics
NPI:1427139690
Name:GANJU, ABHILASHA (MD)
Entity type:Individual
Prefix:
First Name:ABHILASHA
Middle Name:
Last Name:GANJU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ABHI
Other - Middle Name:
Other - Last Name:GANJU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:5600 WOLF RD
Mailing Address - Street 2:#135
Mailing Address - City:WESTERN SPRINGS
Mailing Address - State:IL
Mailing Address - Zip Code:60558-2254
Mailing Address - Country:US
Mailing Address - Phone:708-246-4515
Mailing Address - Fax:708-246-4502
Practice Address - Street 1:5600 WOLF RD
Practice Address - Street 2:#135
Practice Address - City:WESTERN SPRINGS
Practice Address - State:IL
Practice Address - Zip Code:60558-2254
Practice Address - Country:US
Practice Address - Phone:708-246-4515
Practice Address - Fax:708-246-4502
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK15531Medicare ID - Type UnspecifiedMEDICAR
ILD13067Medicare UPIN