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General NPI Number Information
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NPI Number | 1689808933
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Entity Type | Organization
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Legal Business Name | ILLINOIS PHYSICIAN SERVICES LTD
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Dates
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Enumeration Date | 05/14/2009
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Last Update Date | 12/21/2009
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Provider Practice Location Address
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Address Line | 534 CHESTNUT ST SUITE 240
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City | HINSDALE
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State | IL
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Zip | 60521-3167
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Country | US
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Telephone | 312-880-0085
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Fax |
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Provider Business Mailing Address
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Address Line | 1515 S PRAIRIE AVE UNIT 1306
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City | CHICAGO
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State | IL
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Zip | 60605-3043
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | PRAVEEN KHILNANI
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Credential | MD
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Telephone | 312-880-0085
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085U0001X
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Taxonomy Name | Diagnostic Ultrasound Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 042619484
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License Number State | IL
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