Provider Demographics
NPI:1902818768
Name:HANSRA-GODFREY, INDERJIT K (MD, MS)
Entity Type:Individual
Prefix:
First Name:INDERJIT
Middle Name:K
Last Name:HANSRA-GODFREY
Suffix:
Gender:F
Credentials:MD, MS
Other - Prefix:
Other - First Name:INDERJIT
Other - Middle Name:K
Other - Last Name:HANSRA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD, MS
Mailing Address - Street 1:700 E OGDEN AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-5569
Mailing Address - Country:US
Mailing Address - Phone:630-789-9785
Mailing Address - Fax:630-789-9798
Practice Address - Street 1:700 E OGDEN AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:WESTMONT
Practice Address - State:IL
Practice Address - Zip Code:60559-5569
Practice Address - Country:US
Practice Address - Phone:630-789-9785
Practice Address - Fax:630-789-9798
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2015-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036109458207RP1001X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036109458Medicaid
ILP00926067OtherRAILROAD MEDICARE
IL605710007Medicare PIN
IL547700010Medicare PIN