Healthcare Provider Details

I. General information

NPI: 1881277911
Provider Name (Legal Business Name): SANA H KHADRI DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2021
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 N SCHUYLER AVE STE 205
KANKAKEE IL
60901-3601
US

IV. Provider business mailing address

779 LENOX AVE
BOLINGBROOK IL
60490-4981
US

V. Phone/Fax

Practice location:
  • Phone: 815-348-4508
  • Fax:
Mailing address:
  • Phone: 630-818-7173
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number036.181492
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: