Healthcare Provider Details

I. General information

NPI: 1821019506
Provider Name (Legal Business Name): RAJ KHURANA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 07/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 W ROOSEVELT RD
CHICAGO IL
60624-4225
US

IV. Provider business mailing address

4177 S ARCHER AVE
CHICAGO IL
60632-1849
US

V. Phone/Fax

Practice location:
  • Phone: 773-638-6761
  • Fax: 773-762-4527
Mailing address:
  • Phone: 773-254-2222
  • Fax: 773-254-8444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036049058
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: