Provider Demographics
NPI:1508161829
Name:EDITH KHURANA MD SC
Entity Type:Organization
Organization Name:EDITH KHURANA MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:EDITH
Authorized Official - Middle Name:B
Authorized Official - Last Name:KHURANA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-583-6955
Mailing Address - Street 1:2510 W IRVING PARK RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-3748
Mailing Address - Country:US
Mailing Address - Phone:773-583-6955
Mailing Address - Fax:773-604-2201
Practice Address - Street 1:2510 W IRVING PARK RD
Practice Address - Street 2:SUITE D
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-3748
Practice Address - Country:US
Practice Address - Phone:773-583-6955
Practice Address - Fax:773-604-2201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-18
Last Update Date:2011-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-083589207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8R3174OtherBCBS
TXF88777Medicare UPIN