Healthcare Provider Details

I. General information

NPI: 1255454625
Provider Name (Legal Business Name): KISHORE LAKHANI MDSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 01/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 WEST HIGGINS ROAD SUITE 330
HOFFMAN ESTATES IL
60169-7207
US

IV. Provider business mailing address

PO BOX 696
BLOOMINGDALE IL
60108-0696
US

V. Phone/Fax

Practice location:
  • Phone: 847-882-6060
  • Fax: 847-882-6061
Mailing address:
  • Phone: 847-882-6060
  • Fax: 847-882-6061

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number036061273
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number36061273
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number036061273
License Number StateIL

VIII. Authorized Official

Name: ALAN B HESTER II
Title or Position: BILLER
Credential:
Phone: 773-827-7000