GANAPATHI GOTTUMUKKALA NPI 1962457614

NPI Information

  • NPI: 1962457614
  • Provider Name: GANAPATHI GOTTUMUKKALA
  • Classification: Family Medicine - 207Q00000X
  • Entity Type: Organization
  • Address: 6701 159TH ST
    SUITE B
    TINLEY PARK, IL
    ZIP 60477
  • Phone: (708) 614-0893

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NPI Details

GANAPATHI GOTTUMUKKALA is a family medicine in Tinley Park, IL. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. GANAPATHI GOTTUMUKKALA NPI is 1962457614. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

6701 159TH ST
SUITE B
TINLEY PARK, IL
ZIP 60477-758
Phone: (708) 614-0893
Fax: (708) 342-1481

The provider's authorized official is Ganapathi Gottumukkala .
The authorized official title is Sole Proprietor and has the following contact phone number (708) 614-0893.

The enumeration date for this NPI number is 5/23/2006 and was last updated on 11/25/2009.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1207Q00000XFamily Medicine036-074987ILLINOISYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
101625532OTHERILLINOISBCBSIL GROUP #
2570900MEDICARE PINILLINOIS
3080052428MEDICARE PINILLINOIS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

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