Healthcare Provider Details

I. General information

NPI: 1669434353
Provider Name (Legal Business Name): ANJALI KHER M.D. S.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANJALI A PETHKAR M.D. S.C.

II. Dates (important events)

Enumeration Date: 04/06/2006
Last Update Date: 11/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13415 S ROUTE 59
PLAINFIELD IL
60585-5676
US

IV. Provider business mailing address

PO BOX 9200
NAPERVILLE IL
60567-0200
US

V. Phone/Fax

Practice location:
  • Phone: 815-609-3627
  • Fax: 815-609-1328
Mailing address:
  • Phone: 815-609-3627
  • Fax: 815-609-1328

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036104529
License Number StateIL

VII. Legacy identifiers

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

# 1
Identifier09932022
Identifier TypeOTHER
Identifier StateIL
Identifier IssuerBLUE CROSS BLUE SHIELD
# 2
Identifier036104529
Identifier TypeMEDICAID
Identifier StateIL
Identifier Issuer
# 3
Identifier769437
Identifier TypeOTHER
Identifier StateIL
Identifier IssuerAETNA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: