Provider Demographics
NPI:1063512325
Name:KHER, NITIN (MD)
Entity Type:Individual
Prefix:
First Name:NITIN
Middle Name:
Last Name:KHER
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:PO BOX 787
Mailing Address - Street 2:
Mailing Address - City:MCHENRY
Mailing Address - State:IL
Mailing Address - Zip Code:60051-9013
Mailing Address - Country:US
Mailing Address - Phone:224-238-4160
Mailing Address - Fax:847-214-9489
Practice Address - Street 1:690 E TERRA COTTA AVE STE A
Practice Address - Street 2:
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-3605
Practice Address - Country:US
Practice Address - Phone:815-307-8075
Practice Address - Fax:815-344-4302
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036085008207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILDP2616OtherRAILROAD MEDICARE
IL036085008Medicaid
ILP00742097OtherRAILROAD MEDICARE
IL05620217OtherBCBS OF IL
ILG67975Medicare UPIN
ILIL2217001Medicare PIN
ILIL1328001Medicare PIN
ILP00742097OtherRAILROAD MEDICARE
IL05620217OtherBCBS OF IL
ILIL2217Medicare PIN
ILIL1329001Medicare PIN