Provider Demographics
NPI:1689028953
Name:KHAPEKAR, ANUSHA (DO)
Entity Type:Individual
Prefix:
First Name:ANUSHA
Middle Name:
Last Name:KHAPEKAR
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:ANUSHA
Other - Middle Name:
Other - Last Name:MOOLKY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:806 DEER TRAIL LN
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-7706
Mailing Address - Country:US
Mailing Address - Phone:708-582-3797
Mailing Address - Fax:
Practice Address - Street 1:1106 NEAL AVE
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60433-2548
Practice Address - Country:US
Practice Address - Phone:815-727-8670
Practice Address - Fax:815-740-8149
Is Sole Proprietor?:No
Enumeration Date:2016-04-22
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1689028953208000000X
IL336.109955208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics