MEDICARE: DUA KANWAL IQBAL KALOTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	85.011629	IL

General Provider Information

NPI Number	:	1609678804
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DUA KANWAL IQBAL KALOTA

Provider Business Mailing Address
First Line	:	54 W 19TH ST
Second Line	:
City	:	LOMBARD
State	:	IL
Zip	:	60148-4971
Country	:	US
Telephone Number	:	630-827-2977
Fax Number	:

Provider Business Practice Location Address
First Line	:	403 W GALENA BLVD STE 109
Second Line	:
City	:	AURORA
State	:	IL
Zip	:	60506-3948
Country	:	US
Telephone Number	:	331-258-9754
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/26/2025
Last Update Date	:	12/10/2025

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