Healthcare Provider Details

I. General information

NPI: 1811045842
Provider Name (Legal Business Name): ANITA LALL KEWALRAMANI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 04/15/2020
Certification Date: 04/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1306 PLAINFIELD RD
DARIEN IL
60561
US

IV. Provider business mailing address

1306 PLAINFIELD RD
DARIEN IL
60561-2703
US

V. Phone/Fax

Practice location:
  • Phone: 630-810-0900
  • Fax: 630-810-0937
Mailing address:
  • Phone: 630-810-0900
  • Fax: 630-810-0937

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA96602
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: