Healthcare Provider Details

I. General information

NPI: 1689808933
Provider Name (Legal Business Name): ILLINOIS PHYSICIAN SERVICES LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2009
Last Update Date: 12/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

534 CHESTNUT ST SUITE 240
HINSDALE IL
60521-3167
US

IV. Provider business mailing address

1515 S PRAIRIE AVE UNIT 1306
CHICAGO IL
60605-3043
US

V. Phone/Fax

Practice location:
  • Phone: 312-880-0085
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number042619484
License Number StateIL

VIII. Authorized Official

Name: PRAVEEN KHILNANI
Title or Position: PRESIDENT
Credential: MD
Phone: 312-880-0085