Provider Demographics
NPI:1023005881
Name:KHANNA, RAMESH R (MD)
Entity Type:Individual
Prefix:
First Name:RAMESH
Middle Name:R
Last Name:KHANNA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1425 N MCLEAN BLVD
Mailing Address - Street 2:STE 900
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123-5724
Mailing Address - Country:US
Mailing Address - Phone:848-888-3070
Mailing Address - Fax:848-888-0513
Practice Address - Street 1:1425 N MCLEAN BLVD
Practice Address - Street 2:STE 900
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-5724
Practice Address - Country:US
Practice Address - Phone:848-888-3070
Practice Address - Fax:848-888-0513
Is Sole Proprietor?:No
Enumeration Date:2005-10-05
Last Update Date:2014-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036053069208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036053069Medicaid
IL036053069Medicaid
ILP00188818Medicare PIN
ILD13022Medicare UPIN
IL488590Medicare ID - Type Unspecified