Healthcare Provider Details

I. General information

NPI: 1235231366
Provider Name (Legal Business Name): PRADEEP A KENI M D S C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2006
Last Update Date: 07/18/2025
Certification Date: 07/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6420 W 127TH ST STE 106
PALOS HEIGHTS IL
60463-2297
US

IV. Provider business mailing address

6420 W 127TH ST STE 106
PALOS HEIGHTS IL
60463-2297
US

V. Phone/Fax

Practice location:
  • Phone: 708-371-3090
  • Fax: 708-371-1529
Mailing address:
  • Phone: 708-371-3090
  • Fax: 708-371-1529

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number0360-46184
License Number StateIL

VIII. Authorized Official

Name: DR. SANJAY P KENI
Title or Position: DOCTOR
Credential: M.D.
Phone: 708-371-3090