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General NPI Number Information
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NPI Number | 1720350275
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Entity Type | Organization
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Legal Business Name | KAHLON SURINDERPAL S
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Dates
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Enumeration Date | 01/30/2012
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Last Update Date | 01/30/2012
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Provider Practice Location Address
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Address Line | 601 N LOGAN AVE
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City | DANVILLE
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State | IL
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Zip | 61832-4320
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Country | US
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Telephone | 217-442-4055
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Fax | 425-795-5915
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Provider Business Mailing Address
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Address Line | 601 N LOGAN AVE
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City | DANVILLE
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State | IL
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Zip | 61832-4320
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Country | US
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Telephone | 217-442-4055
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Fax | 425-795-5915
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Authorized Official
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Title or Position | PSYCHIATRIST
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Name | SURINDERPAL S KAHLON
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Credential | M.D.
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Telephone | 217-497-9090
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 036091614
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License Number State | IL
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