Basic Information
| Provider Information | |||||||||
| NPI: | 1609891712 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ANIL K KHEMANI MD SC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2205 POINT BLVD | ||||||||
| Address2: | SUITE 220 | ||||||||
| City: | ELGIN | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601237840 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2242384160 | ||||||||
| FaxNumber: | 8477830599 | ||||||||
| Practice Location | |||||||||
| Address1: | 3703 DOTY RD | ||||||||
| Address2: | SUITE 4 | ||||||||
| City: | WOODSTOCK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600987517 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8152060025 | ||||||||
| FaxNumber: | 8152060021 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/12/2006 | ||||||||
| LastUpdateDate: | 12/21/2011 | ||||||||
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| AuthorizedOfficialLastName: | KHEMANI | ||||||||
| AuthorizedOfficialFirstName: | ANIL | ||||||||
| AuthorizedOfficialMiddleName: | K | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 8152060025 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 036091226 | IL | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 05620217 | 01 | IL | BCBS | OTHER |