Healthcare Provider Details

I. General information

NPI: 1689028953
Provider Name (Legal Business Name): ANUSHA KHAPEKAR D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANUSHA MOOLKY D.O.

II. Dates (important events)

Enumeration Date: 04/22/2016
Last Update Date: 04/22/2020
Certification Date: 04/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1106 NEAL AVE
JOLIET IL
60433-2548
US

IV. Provider business mailing address

806 DEER TRAIL LN
OAK BROOK IL
60523-7706
US

V. Phone/Fax

Practice location:
  • Phone: 815-727-8670
  • Fax: 815-740-8149
Mailing address:
  • Phone: 708-582-3797
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number1689028953
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number336.109955
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: