Individual
DR. GAGAN GAUTAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD, MCH
Contact information
Practice address
5841 S MARYLAND AVE, J 664, CHICAGO, IL 60637-1447
(773) 575-4165
Mailing address
6033 N SHERIDAN RD, APT 14 D, CHICAGO, IL 60660-3003
(773) 575-4165
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
125.055629
IL
Other
Enumeration date
12/21/2010
Last updated
12/21/2010
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