Provider Demographics
NPI:1033352067
Name:ANGEL HEALTH CARE SERVICES SC
Entity Type:Organization
Organization Name:ANGEL HEALTH CARE SERVICES SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KISHORE
Authorized Official - Middle Name:
Authorized Official - Last Name:KHANKARI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-730-4223
Mailing Address - Street 1:7906 S CRANDON AVE
Mailing Address - Street 2:2
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60617-1146
Mailing Address - Country:US
Mailing Address - Phone:312-730-4223
Mailing Address - Fax:
Practice Address - Street 1:7906 S CRANDON AVE
Practice Address - Street 2:2
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60617-1146
Practice Address - Country:US
Practice Address - Phone:312-730-4223
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-07
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036104389207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty