Provider Demographics
NPI:1205000924
Name:KALRA, MANALI DOSHI (MD)
Entity Type:Individual
Prefix:
First Name:MANALI
Middle Name:DOSHI
Last Name:KALRA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MANALI
Other - Middle Name:
Other - Last Name:DOSHI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1123 W GRACE ST
Mailing Address - Street 2:#3E
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-3250
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3001 GREEN BAY RD
Practice Address - Street 2:
Practice Address - City:NORTH CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60064-3048
Practice Address - Country:US
Practice Address - Phone:224-610-7151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-14
Last Update Date:2012-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.123163207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL205785OtherESC GROUP MEDICARE COOK CO
IL205786OtherESC GROUP MEDICARE DUPAGE CO
IL1083684922OtherTHE EYE SPECIALIST CENTER, LLC GRP NPI
IL1699802421OtherESC OPTICAL GRP NPI NUMBER
IL2057850055OtherINDIVIDUAL PTAN
IL2057850055OtherINDIVIDUAL PTAN