Healthcare Provider Details

I. General information

NPI: 1558620146
Provider Name (Legal Business Name): RAUNAK SUNIL KHISTY MD, MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2012
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12255 S 80TH AVE STE 202
PALOS HEIGHTS IL
60463-1284
US

IV. Provider business mailing address

12255 S 80TH AVE STE 202
PALOS HEIGHTS IL
60463-1284
US

V. Phone/Fax

Practice location:
  • Phone: 708-923-7878
  • Fax: 708-923-7888
Mailing address:
  • Phone: 708-923-7878
  • Fax: 708-923-7888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number036144216
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number036144216
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: