Individual provider Active NPI

Insiyah Aamir Gomberawalla, M.D.

  • Pediatrics Physician
  • Palos Park, IL
National Provider Identifier
1508283573
Registry record updated Apr 1, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
125.064759 Issued in IL
Practice address
12716 S Misty Harbour LN
Palos Park, IL 60464-2570
Phone
(408) 507-7861
NPI assigned
Mar 27, 2014
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 1, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 125.064759 IL Primary

Addresses

Primary practice location

12716 S Misty Harbour LN
Palos Park, IL 60464-2570

Mailing address

12716 S Misty Harbour LN
Palos Park, IL 60464-2570
Phone (408) 507-7861

Other names 1

  • Insiyah Nomanbhoy Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
125.064759ILMDPediatrics Physician

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1395878400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1743465600000",
    "number": "1508283573",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12716 S MISTY HARBOUR LN",
            "city": "PALOS PARK",
            "state": "IL",
            "postal_code": "604642570",
            "telephone_number": "408-507-7861"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12716 S MISTY HARBOUR LN",
            "city": "PALOS PARK",
            "state": "IL",
            "postal_code": "604642570",
            "telephone_number": "408-507-7861"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOMBERAWALLA",
        "first_name": "INSIYAH",
        "middle_name": "AAMIR",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-03-27",
        "last_updated": "2025-04-01",
        "certification_date": "2025-04-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "IL",
            "license": "125.064759",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "INSIYAH",
            "last_name": "NOMANBHOY",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Palos Park, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.