Provider Demographics
NPI:1063651305
Name:ANARKALI INTERNISTS SC
Entity Type:Organization
Organization Name:ANARKALI INTERNISTS SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:A
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-354-7041
Mailing Address - Street 1:4647 LINCOLN HWY
Mailing Address - Street 2:
Mailing Address - City:MATTESON
Mailing Address - State:IL
Mailing Address - Zip Code:60443-2319
Mailing Address - Country:US
Mailing Address - Phone:708-915-7190
Mailing Address - Fax:708-915-7194
Practice Address - Street 1:1035 N MARION ST
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60302-1374
Practice Address - Country:US
Practice Address - Phone:773-354-7041
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-10
Last Update Date:2016-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036094223207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036094223Medicaid
IL1629282OtherBLUE CROSS BLUE SHIELD
ILIL1790001Medicare PIN
IL036094223Medicaid
ILIL1716001Medicare PIN
ILIL1716Medicare PIN