Healthcare Provider Details

I. General information

NPI: 1700936390
Provider Name (Legal Business Name): SANDHYA R KARNA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 08/17/2020
Certification Date: 08/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3922 MERCY DR
MCHENRY IL
60050-3151
US

IV. Provider business mailing address

3922 MERCY DR
MCHENRY IL
60050-3151
US

V. Phone/Fax

Practice location:
  • Phone: 815-344-4499
  • Fax: 815-344-4779
Mailing address:
  • Phone: 815-344-4499
  • Fax: 815-344-4779

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036103438
License Number StateIL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierKARNASAN
Identifier TypeOTHER
Identifier StateWI
Identifier IssuerMERCY CARE INSURANCE
# 2
Identifier036103438 2
Identifier TypeMEDICAID
Identifier StateIL
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: