DR. GANAPATHI R GOTTUMUKKALA (NPI# 1780683953) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1780683953 |
| Entity Type | Individual |
| Full Name | DR. GANAPATHI R GOTTUMUKKALA |
| Credential | M.D. |
| Practice Address |
6701 159th St Suite B Tinley Park IL 60477-1758 |
| Mailing Address |
Po Box 849 Matteson IL 60443-0849 |
| Practice Telephone | 7086140893 |
| Practice Fax Number | 7083421481 |
| Mailing Telephone | 7087475850 |
| Mailing Fax Number | 7087479991 |
| Enumeration Date | 2005-07-19 |
| Last Update Date | 2009-11-25 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | 036074987 | IL | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | BLUE SHIELD PROVIDER # | 01625532 | 01 |
| IL | 036074987 | 05 |
| Street Address |
6701 159TH ST SUITE B |
| City | TINLEY PARK |
| State | IL |
| Zip Code | 60477-1758 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124027651 | Frank J. Kniffen | Anesthesiology | 6701 159th St, Ingalls Same Day Surgery, Tinley Park, IL 60477-1758 | 2005-07-18 |
| 1659878635 | Lena Modieh | Nurse Practitioner | 6701 159th St, Tinley Park, IL 60477 | 2018-04-06 |
| 1740664630 | Annette Krapil | Pharmacist | 6701 159th St, Tinley Park, IL 60477-1758 | 2015-07-10 |
| 1063844934 | Primary Healthcare Associates, Sc | Non-Pharmacy Dispensing Site | 6701 159th St, Suite 1, Tinley Park, IL 60477-1758 | 2013-08-02 |
| 1154675700 | Donald A Williams Jr. | Physical Therapist | 6701 159th St, Tinley Park, IL 60477-1758 | 2012-11-05 |
| 1982953881 | Elizabeth Gezaw | Physical Therapist | 6701 159th St, Tinley Park, IL 60477-1758 | 2012-09-06 |
| 1487829990 | Medcentrix Inc. | Pharmacy | 6701 159th St, Tinley Park, IL 60477-1758 | 2008-04-25 |
| 1477747939 | Associated Urological Specialists LLC | Radiology | 6701 159th St, Tinley Park, IL 60477-1758 | 2007-08-28 |
| 1669687307 | James Alfred Wallace | Internal Medicine | 6701 159th St, Suite 1, Tinley Park, IL 60477-1758 | 2007-05-14 |
| 1134257801 | Walid Kandah | Emergency Medicine | 6701 159th St, Tinley Park, IL 60477-1758 | 2007-03-02 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013522366 | Joshua Gruenke | Physical Therapist | 17129 S. Harlem Avenue, Tinley Park, IL 60477 | 2020-09-14 |
| 1881229656 | Sherrie Lynn Tsang | Massage Therapist | 7925 West 171st Street, Tinley Park, IL 60477 | 2020-03-11 |
| 1437782117 | Du Page Medical Group Ltd | Durable Medical Equipment & Medical Supplies | 17129 S Harlem Ave. Ste B3, Tinley Park, IL 60477 | 2020-02-20 |
| 1356998561 | Rasa Vaskeviciute | Physical Therapist | 17129 So Harlem, Tinley Park, IL 60477 | 2019-08-22 |
| 1538728258 | Michelle Anne Wisen | Physical Therapy Assistant | 17129 South Harlem, Suite B3, Tinley Park, IL 60477 | 2019-06-06 |
| 1073006151 | Danielle Lyon | Counselor | 6801 West 180th Court, Tinley Park, IL 60477 | 2018-06-13 |
| 1316445794 | Yvonne Tran | Physical Therapist | 17129 S Harlem Ave, Tinley Park, IL 60477 | 2018-01-31 |
| 1326574591 | Nicholas Barker | Chronic Disease Hospital | 7859 Joliet Drive North, Tinley Park, IL 60477 | 2017-05-10 |
| 1982063632 | Nicole Kristine Demarco | Specialist/Technologist | 16317 Clark Ln, Tinley Park, IL 60477 | 2016-02-22 |
| 1376900571 | Ucp Seguin Greater Chicago | Foster Care Agency | 7550 W. 183rd, Tinley Park, IL 60477 | 2016-01-20 |
| Find all providers in zip 60477 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| 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. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073991345 | Yifei Du | Family Medicine | 16650 Harlem Ave Ste 6, Tinley Park, IL 60477-1847 | 2015-05-07 |
| 1669762639 | Midway Disc and Spine Center II Ltd | Family Medicine | 16650 S. Harlem, Suite 4, Tinley Park, IL 60477 | 2011-04-12 |
| 1316008329 | Sheldon Allen Levine | Family Medicine | 16750 S 80th Ave, Suite B, Tinley Park, IL 60477-3173 | 2006-12-13 |
| 1871698860 | Maurice J Halpin | Family Medicine | 16641 Ridgeland Ave, Tinley Park, IL 60477-1869 | 2006-09-14 |
| 1013926625 | Rd Woods Md LLC | Family Medicine | 6800 Centennial Dr, Suite D, Tinley Park, IL 60477-1608 | 2006-08-05 |
| 1588616296 | Saleem Shahzad | Family Medicine | 16650 Harlem Ave Ste 1, Tinley Park, IL 60477-1847 | 2006-05-17 |
| 1528023736 | Anand Y Talcherkar | Family Medicine | 8051 W 186th St, Tinley Park, IL 60487 | 2006-04-19 |
| 1619944857 | Kimberly Middleton | Family Medicine | 17859 80th Ave, Tinley Park, IL 60477-5023 | 2006-03-07 |
| 1184626673 | Scott R Lowry | Family Medicine | 9501 171st St Ste Q, Tinley Park, IL 60487 | 2005-08-15 |
| 1275539009 | Amin Yassin | Family Medicine | 16750 South 80th Ave, Tinley Park, IL 60477 | 2005-06-27 |
| Find all providers in TINLEY PARK | ||||
| City | TINLEY PARK |
| Zip Code | 60477 |
Please comment or provide details below to improve the information on DR. GANAPATHI R GOTTUMUKKALA.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.