Healthcare Provider Details

I. General information

NPI: 1750389953
Provider Name (Legal Business Name): ANIL K KHEMANI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2005
Last Update Date: 09/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 LAKE AVE
WOODSTOCK IL
60098-7401
US

IV. Provider business mailing address

2000 LAKE AVE
WOODSTOCK IL
60098-7401
US

V. Phone/Fax

Practice location:
  • Phone: 815-337-7100
  • Fax: 815-337-4700
Mailing address:
  • Phone: 815-337-7100
  • Fax: 815-337-4700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number036091226
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: