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General NPI Number Information
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NPI Number | 1124228424
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Entity Type | Organization
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Legal Business Name | KESHAVA MEDICAL CENTER LTD
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Dates
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Enumeration Date | 07/24/2007
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Last Update Date | 06/29/2010
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Provider Practice Location Address
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Address Line | 7845 S COTTAGE GROVE AVE SUITE # 109
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City | CHICAGO
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State | IL
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Zip | 60619-3100
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Country | US
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Telephone | 773-783-8793
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Fax | 773-783-8794
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Provider Business Mailing Address
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Address Line | 9000 KILKENNY DR
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City | DARIEN
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State | IL
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Zip | 60561-8451
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Country | US
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Telephone | 630-910-8157
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. PRAMODE K KESHAVA
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Credential | M.D.
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Telephone | 773-783-8793
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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 | 036094000
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License Number State | IL
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