Provider Demographics
NPI:1114397056
Name:INNOVATIVE PLATINUM CARE, SC
Entity Type:Organization
Organization Name:INNOVATIVE PLATINUM CARE, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAHUL
Authorized Official - Middle Name:
Authorized Official - Last Name:KHARE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-270-5600
Mailing Address - Street 1:2400 N ASHLAND AVE
Mailing Address - Street 2:SUITE 150
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-2021
Mailing Address - Country:US
Mailing Address - Phone:773-270-5600
Mailing Address - Fax:773-360-7378
Practice Address - Street 1:2400 N ASHLAND AVE
Practice Address - Street 2:SUITE 150
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-2021
Practice Address - Country:US
Practice Address - Phone:773-270-5600
Practice Address - Fax:773-360-7378
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-05
Last Update Date:2016-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36111153207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty