Healthcare Provider Details

I. General information

NPI: 1811006315
Provider Name (Legal Business Name): RAJEEV KHANNA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2615 HARRISON ST
BELLWOOD IL
60104-2450
US

IV. Provider business mailing address

2615 HARRISON ST
BELLWOOD IL
60104-2450
US

V. Phone/Fax

Practice location:
  • Phone: 708-493-0299
  • Fax: 708-493-0594
Mailing address:
  • Phone: 708-493-0299
  • Fax: 708-493-0594

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: