Provider Demographics
NPI:1689808933
Name:ILLINOIS PHYSICIAN SERVICES LTD
Entity Type:Organization
Organization Name:ILLINOIS PHYSICIAN SERVICES LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PRAVEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:KHILNANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-880-0085
Mailing Address - Street 1:1515 S PRAIRIE AVE
Mailing Address - Street 2:UNIT 1306
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60605-3043
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:534 CHESTNUT ST
Practice Address - Street 2:SUITE 240
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-3167
Practice Address - Country:US
Practice Address - Phone:312-880-0085
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-14
Last Update Date:2009-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Q00000X, 2085R0202X, 2085R0204X, 2085U0001X
IL042619484208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Multi-Specialty
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic UltrasoundGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL2423Medicare PIN