MEDICARE: VILAS KHANDEPARKER 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	208800000X	Urology Physician	036047940	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

General Provider Information

NPI Number	:	1811951932
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VILAS KHANDEPARKER M.D.

Provider Business Mailing Address
First Line	:	6084 S ARCHER AVE
Second Line	:	SUITE 202
City	:	CHICAGO
State	:	IL
Zip	:	60638-2747
Country	:	US
Telephone Number	:	773-581-5888
Fax Number	:	773-581-5895

Provider Business Practice Location Address
First Line	:	6084 S ARCHER AVE
Second Line	:	SUITE 202
City	:	CHICAGO
State	:	IL
Zip	:	60638-2747
Country	:	US
Telephone Number	:	773-581-5888
Fax Number	:	773-581-5895

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

Provider Enumeration Date	:	04/14/2006
Last Update Date	:	03/13/2009

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