Provider Demographics
NPI:1063689941
Name:KHANDELWAL, ABHA (MD)
Entity Type:Individual
Prefix:
First Name:ABHA
Middle Name:
Last Name:KHANDELWAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:545 N DEARBORN ST
Mailing Address - Street 2:APT 1311
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60654-2658
Mailing Address - Country:US
Mailing Address - Phone:312-775-2242
Mailing Address - Fax:
Practice Address - Street 1:300 PASTEUR DRIVE
Practice Address - Street 2:FALK CVRC 158
Practice Address - City:STANFORD
Practice Address - State:CA
Practice Address - Zip Code:94305-5406
Practice Address - Country:US
Practice Address - Phone:650-723-5566
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-10
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA126558207RC0000X
IL125-049596207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine