Provider Demographics
NPI:1053342428
Name:KAMBOJ, GINNY (MD)
Entity type:Individual
Prefix:
First Name:GINNY
Middle Name:
Last Name:KAMBOJ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:661 RIDGEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:MCHENRY
Mailing Address - State:IL
Mailing Address - Zip Code:60050-7012
Mailing Address - Country:US
Mailing Address - Phone:815-307-8075
Mailing Address - Fax:815-344-4302
Practice Address - Street 1:661 RIDGEVIEW DR
Practice Address - Street 2:
Practice Address - City:MCHENRY
Practice Address - State:IL
Practice Address - Zip Code:60050-7012
Practice Address - Country:US
Practice Address - Phone:815-307-8075
Practice Address - Fax:815-344-4302
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036102484207RH0000X, 207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00987298Medicare PIN
H25576Medicare UPIN
ILIL2921001Medicare PIN
ILIL2920001Medicare PIN