Healthcare Provider Details

I. General information

NPI: 1124130240
Provider Name (Legal Business Name): SHARAD K KHANDELWAL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3245 GROVE AVE
BERWYN IL
60402-3474
US

IV. Provider business mailing address

3245 GROVE AVE
BERWYN IL
60402-3474
US

V. Phone/Fax

Practice location:
  • Phone: 708-795-0100
  • Fax: 708-795-0101
Mailing address:
  • Phone: 708-795-0100
  • Fax: 708-795-0101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: