Physician Compare National (NPI:1720273378)

HEALTHCARE PROVIDER: SANJAY PRADEEP KENI M.D.

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1720273378
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	1850571597
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20110427000168
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	KENI
	Individual professional last name
Provider First Name	SANJAY
	Individual professional first name
Provider Middle Name	P
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	NORTHWESTERN UNIVERSITY FEINBERG MEDICAL SCHOOL
	Individual professional's medical school
Graduation Year	1998
	Individual professional's medical school graduation year
Primary Specialty	OTOLARYNGOLOGY
	Primary medical specialty reported by the individual professional in the selected enrollment
Secondary Specialty 1	PLASTIC AND RECONSTRUCTIVE SURGERY
	First secondary medical specialty reported by the individual professional in the selected enrollment
All Secondary Specialties	PLASTIC AND RECONSTRUCTIVE SURGERY
	All four secondary specialties reported by the individual professional in the selected enrollment, separated by commas

Practice Information
Line 1 Street Address	6600 W COLLEGE DR
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 104
	Group Practice or individual's line 2 address
City	PALOS HEIGHTS
	Group Practice or individual's city
State	IL
	Group Practice or individual's state
Zip Code	604631796
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	140242
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	CENTRAL DUPAGE HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	140062
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	PALOS COMMUNITY HOSPITAL
	Legal business name of hospital where individual professional provides service 2
Professional Accepts Medicare Assignment	Y