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Individual

JAGAN K KANSAL

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D

Contact information

Practice address
1030 N CLARK ST STE 310, CHICAGO, IL 60610-5413
(312) 620-1803
Mailing address
20706 CARDINAL CT, FRANKFORT, IL 60423-3106
(312) 620-1803

Taxonomy

Speciality
Code
Description
License number
State
208800000X
Urology Physician
01097404A
IN
208800000X
Urology Physician
Primary
036-153180
IL
208800000X
Urology Physician
70572
WI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1942611694
WI
05
300116993
IN
Enumeration date
05/15/2014
Last updated
12/16/2025
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