Healthcare Provider Details

I. General information

NPI: 1346225836
Provider Name (Legal Business Name): NARINDER N KHANNA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2005
Last Update Date: 12/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 N 9TH ST
SPRINGFIELD IL
62702-5317
US

IV. Provider business mailing address

PO BOX 19676
SPRINGFIELD IL
62794-9676
US

V. Phone/Fax

Practice location:
  • Phone: 800-331-2229
  • Fax: 217-757-6844
Mailing address:
  • Phone: 800-331-2229
  • Fax: 217-757-6844

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number036-053716
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: