Individual
DR. AJEET D GORDHAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2200 FORT JESSE RD, SUITE 280, NORMAL, IL 61761-6286
(309) 452-1788
(309) 862-1302
Mailing address
2200 FORT JESSE RD, SUITE 280, NORMAL, IL 61761-6286
(309) 452-1788
(309) 862-1302
Taxonomy
Speciality
Code
Description
License number
State
2085N0700X
Neuroradiology Physician
Primary
36110222
IL
2085R0202X
Diagnostic Radiology Physician
36110222
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036110222*1
—
IL
Enumeration date
05/25/2006
Last updated
11/16/2016
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