Provider Demographics
NPI:1093296121
Name:MAX HEALTHCARE CONSULTANT PLLC
Entity Type:Organization
Organization Name:MAX HEALTHCARE CONSULTANT PLLC
Other - Org Name:MAX HEALTHCARE CONSULTANT PLLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:NITIN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHANANA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-240-3576
Mailing Address - Street 1:4601 GLOBE WILLOW DR STE 100
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79922-2221
Mailing Address - Country:US
Mailing Address - Phone:630-240-3576
Mailing Address - Fax:
Practice Address - Street 1:7888 GATEWAY BLVD E FL 2
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79915
Practice Address - Country:US
Practice Address - Phone:915-315-2584
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MAX HEALTHCARE CONSULTANT PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-08-27
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK33554208000000X, 2080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric CardiologyGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1962634188OtherINDIVIDUAL NPI FOR NITIN CHANANA