Provider Demographics
NPI:1093803975
Name:SANTWANI, KISHORE M
Entity Type:Individual
Prefix:DR
First Name:KISHORE
Middle Name:M
Last Name:SANTWANI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 RANDALL RD STE 204
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:IL
Mailing Address - Zip Code:60134-4219
Mailing Address - Country:US
Mailing Address - Phone:630-208-7790
Mailing Address - Fax:630-208-7791
Practice Address - Street 1:302 RANDALL RD STE 204
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:IL
Practice Address - Zip Code:60134-4219
Practice Address - Country:US
Practice Address - Phone:630-208-7790
Practice Address - Fax:630-208-7791
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2019-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0361138672084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology