Healthcare Provider Details

I. General information

NPI: 1043424450
Provider Name (Legal Business Name): MAYA FAMILY MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4527 N PULASKI RD
CHICAGO IL
60630
US

IV. Provider business mailing address

4527 N PULASKI RD
CHICAGO IL
60630
US

V. Phone/Fax

Practice location:
  • Phone: 773-267-6617
  • Fax: 773-267-0460
Mailing address:
  • Phone: 773-267-6617
  • Fax: 773-267-0460

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code2080P0208X
TaxonomyPediatric Infectious Diseases Physician
License Number
License Number StateIL

VIII. Authorized Official

Name: DR. CHANDRA MOHINI KHURANA
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 773-267-6617