Provider Demographics
NPI:1326123381
Name:NAGPAL, KRISHAN C (MD)
Entity Type:Individual
Prefix:DR
First Name:KRISHAN
Middle Name:C
Last Name:NAGPAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:KRISHAN
Other - Middle Name:C
Other - Last Name:NAGPAL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:360 W BUTTERFIELD RD
Mailing Address - Street 2:SUITE 245
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-5068
Mailing Address - Country:US
Mailing Address - Phone:630-832-3055
Mailing Address - Fax:630-832-0927
Practice Address - Street 1:360 W BUTTERFIELD RD
Practice Address - Street 2:SUITE 245
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-5068
Practice Address - Country:US
Practice Address - Phone:630-832-3055
Practice Address - Fax:630-832-0927
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-048014207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL2200979OtherBCBS PROVIDER NO
IL18191089AOtherRAILROAD MEDICARE PIN
IL18191089AOtherRAILROAD MEDICARE PIN
ILD12893Medicare UPIN
IL0663930001Medicare NSC