Healthcare Provider Details

I. General information

NPI: 1851501498
Provider Name (Legal Business Name): ANJALI KHER, M.D., S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 10/31/2007
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
Identifier036104529
Identifier TypeMEDICAID
Identifier StateIL
Identifier Issuer

VIII. Authorized Official

Name: DR. ANJALI KHER
Title or Position: PRESIDENT
Credential: M.D.
Phone: 815-609-3627