Individual
GAYATHRI GANESH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
333 N MICHIGAN AVE STE 1400, CHICAGO, IL 60601-4011
(312) 815-9660
Mailing address
333 N MICHIGAN AVE STE 1400, CHICAGO, IL 60601-4011
(312) 815-9660
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
25MP00678000
NJ
363A00000X
Physician Assistant
Primary
085009660
IL
Other
Enumeration date
01/18/2022
Last updated
01/30/2024
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