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General NPI Number Information
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NPI Number | 1447308176
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Entity Type | Organization
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Legal Business Name | KEY INTERNAL MEDICINE, S.C.
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Dates
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Enumeration Date | 01/08/2007
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Last Update Date | 06/22/2023
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Provider Practice Location Address
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Address Line | 100 PROVENA WAY STE D
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City | BOURBONNAIS
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State | IL
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Zip | 60914
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Country | US
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Telephone | 815-932-9210
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Fax | 815-932-9220
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Provider Business Mailing Address
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Address Line | PO BOX 715
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City | BOURBONNAIS
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State | IL
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Zip | 60914-0715
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Country | US
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Telephone | 815-932-9210
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Fax | 815-932-9220
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Authorized Official
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Title or Position | OWNER
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Name | DR. DHARAM R ANAND
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Credential | M.D.
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Telephone | 815-932-9210
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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 | 036-076865
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License Number State | IL
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