Provider Demographics
NPI:1518176601
Name:MULTANI, SUKHWINDER S (MD)
Entity Type:Individual
Prefix:
First Name:SUKHWINDER
Middle Name:S
Last Name:MULTANI
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 1:19 OLT AVE
Mailing Address - Street 2:
Mailing Address - City:PEKIN
Mailing Address - State:IL
Mailing Address - Zip Code:61554-6214
Mailing Address - Country:US
Mailing Address - Phone:309-353-6301
Mailing Address - Fax:309-353-1555
Practice Address - Street 1:19 OLT AVE
Practice Address - Street 2:
Practice Address - City:PEKIN
Practice Address - State:IL
Practice Address - Zip Code:61554-6214
Practice Address - Country:US
Practice Address - Phone:309-353-6301
Practice Address - Fax:309-353-1555
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2009-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301084133207Q00000X
IL036122597207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0361225971Medicaid
IL779491OtherMEDICARE PTAN
IL09015685OtherBCBS OF IL
IL779491005Medicare PIN