Healthcare Provider Details

I. General information

NPI: 1891043162
Provider Name (Legal Business Name): KEYUR PAREKH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2012
Last Update Date: 06/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 E CHICAGO AVE
CHICAGO IL
60611-2991
US

IV. Provider business mailing address

2930 N SHERIDAN RD APT 705
CHICAGO IL
60657-5964
US

V. Phone/Fax

Practice location:
  • Phone: 312-227-4000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number125.061672
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: