Provider Demographics
NPI:1497773295
Name:KHEDKAR, NANDA (MD)
Entity Type:Individual
Prefix:MR
First Name:NANDA
Middle Name:
Last Name:KHEDKAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 SAINT FRANCIS CIR
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-2560
Mailing Address - Country:US
Mailing Address - Phone:847-759-1002
Mailing Address - Fax:847-759-1009
Practice Address - Street 1:249 S RIVER RD
Practice Address - Street 2:
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60016-3436
Practice Address - Country:US
Practice Address - Phone:847-759-1005
Practice Address - Fax:847-759-1009
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2017-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36-049550207UN0901X
IL036-049550207UN0902X, 2085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207UN0902XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Imaging & Therapy
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036049550Medicaid
IL036049550Medicaid
ILE42764Medicare UPIN