MEDICARE: SANJEEB KHATUA M.D.

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	207Q00000X	Family Medicine Physician	036123917	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	9933040	OTHER	IL	BCBS

General Provider Information

NPI Number	:	1770777658
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANJEEB KHATUA M.D.

Provider Business Mailing Address
First Line	:	16519 S RTE 59
Second Line	:
City	:	PLAINFIELD
State	:	IL
Zip	:	60586-2606
Country	:	US
Telephone Number	:	630-646-5020
Fax Number	:	630-646-5025

Provider Business Practice Location Address
First Line	:	16519 S RTE 59
Second Line	:
City	:	PLAINFIELD
State	:	IL
Zip	:	60586-2606
Country	:	US
Telephone Number	:	630-646-5020
Fax Number	:	630-646-5025

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

Provider Enumeration Date	:	09/04/2007
Last Update Date	:	06/05/2013

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Directions to “ SANJEEB KHATUA M.D.” Practice Location

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