Provider Demographics
NPI:1477708204
Name:CENTER FOR ADULT HEALTHCARE SC
Entity Type:Organization
Organization Name:CENTER FOR ADULT HEALTHCARE SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MANDEEP
Authorized Official - Middle Name:S
Authorized Official - Last Name:KOHLI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:630-893-0347
Mailing Address - Street 1:PO BOX 6365
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60108-6365
Mailing Address - Country:US
Mailing Address - Phone:630-893-0347
Mailing Address - Fax:630-893-1467
Practice Address - Street 1:303 E ARMY TRAIL RD
Practice Address - Street 2:SUITE 301
Practice Address - City:BLOOMINGDALE
Practice Address - State:IL
Practice Address - Zip Code:60108-2169
Practice Address - Country:US
Practice Address - Phone:630-893-0347
Practice Address - Fax:630-893-1467
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-20
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL201424Medicare UPIN
IL208828Medicare PIN