Provider Demographics
NPI:1629030630
Name:MAHAJAN, PRITI KHANNA (MD)
Entity Type:Individual
Prefix:DR
First Name:PRITI
Middle Name:KHANNA
Last Name:MAHAJAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:PRITI
Other - Middle Name:
Other - Last Name:KHANNA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:401 N MICHIGAN AVE
Mailing Address - Street 2:SUITE 1200
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-4264
Mailing Address - Country:US
Mailing Address - Phone:312-635-0973
Mailing Address - Fax:813-290-9691
Practice Address - Street 1:8200 ROOSEVELT RD
Practice Address - Street 2:
Practice Address - City:FOREST PARK
Practice Address - State:IL
Practice Address - Zip Code:60130-2528
Practice Address - Country:US
Practice Address - Phone:708-488-9850
Practice Address - Fax:708-488-9870
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2016-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036094381208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036094381OtherLICENSE NO
IL036094381Medicaid
ILP01406915OtherRR MEDICARE
IL036094381Medicaid