Healthcare Provider Details

I. General information

NPI: 1336473198
Provider Name (Legal Business Name): SIMRAN JIT KAMBOJ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2009
Last Update Date: 12/29/2022
Certification Date: 12/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21481 N RAND RD
KILDEER IL
60047-3061
US

IV. Provider business mailing address

21481 N RAND RD
KILDEER IL
60047-3061
US

V. Phone/Fax

Practice location:
  • Phone: 847-618-9696
  • Fax: 847-618-9695
Mailing address:
  • Phone: 847-618-9696
  • Fax: 847-618-9695

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number27282
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036131134
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: