Healthcare Provider Details

I. General information

NPI: 1497773295
Provider Name (Legal Business Name): NANDA KHEDKAR M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 03/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

249 S RIVER RD
DES PLAINES IL
60016-3436
US

IV. Provider business mailing address

133 SAINT FRANCIS CIR
OAK BROOK IL
60523-2560
US

V. Phone/Fax

Practice location:
  • Phone: 847-759-1005
  • Fax: 847-759-1009
Mailing address:
  • Phone: 847-759-1002
  • Fax: 847-759-1009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License Number36-049550
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207UN0902X
TaxonomyNuclear Imaging & Therapy Physician
License Number036-049550
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number036-049550
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: