Provider Demographics
NPI:1073675906
Name:KENI, SADHANA (MD)
Entity Type:Individual
Prefix:DR
First Name:SADHANA
Middle Name:
Last Name:KENI
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 1:3811 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-1555
Mailing Address - Country:US
Mailing Address - Phone:630-852-9300
Mailing Address - Fax:630-852-7773
Practice Address - Street 1:3811 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-1555
Practice Address - Country:US
Practice Address - Phone:630-852-9300
Practice Address - Fax:630-852-7773
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL472832Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
ILE47095Medicare UPIN