Provider Demographics
NPI:1376687319
Name:LAKHANI, KISHORE K (MDSC)
Entity Type:Individual
Prefix:
First Name:KISHORE
Middle Name:K
Last Name:LAKHANI
Suffix:
Gender:M
Credentials:MDSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 696
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60108-0696
Mailing Address - Country:US
Mailing Address - Phone:847-882-6060
Mailing Address - Fax:847-882-6061
Practice Address - Street 1:2500 WEST HIGGINS ROAD
Practice Address - Street 2:SUITE 330
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60169-7207
Practice Address - Country:US
Practice Address - Phone:847-882-6060
Practice Address - Fax:847-882-6061
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2011-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036061273207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036061273 2Medicaid
IL2201417OtherBLUE SHIELD PROVIDER NO
IL688070Medicare ID - Type UnspecifiedMEDICARE NUMBER
IL2201417OtherBLUE SHIELD PROVIDER NO