Healthcare Provider Details

I. General information

NPI: 1316866718
Provider Name (Legal Business Name): IMROZKHAN A KALYANI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2026
Last Update Date: 07/11/2026
Certification Date: 07/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4745 MAIN ST STE 207
LISLE IL
60532-1758
US

IV. Provider business mailing address

4745 MAIN ST STE 207
LISLE IL
60532-1758
US

V. Phone/Fax

Practice location:
  • Phone: 630-442-1895
  • Fax:
Mailing address:
  • Phone: 630-442-1895
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number150.129568
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: