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General NPI Number Information
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NPI Number | 1033352067
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Entity Type | Organization
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Legal Business Name | ANGEL HEALTH CARE SERVICES SC
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Dates
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Enumeration Date | 04/07/2009
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Last Update Date | 06/15/2022
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Provider Practice Location Address
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Address Line | 7906 S CRANDON AVE 2
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City | CHICAGO
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State | IL
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Zip | 60617-1146
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Country | US
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Telephone | 312-730-4223
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Fax |
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Provider Business Mailing Address
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Address Line | 7906 S CRANDON AVE 2
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City | CHICAGO
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State | IL
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Zip | 60617-1146
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Country | US
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Telephone | 312-730-4223
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KISHORE KHANKARI
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Credential |
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Telephone | 312-730-4223
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 036104389
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License Number State | IL
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