Provider Demographics
NPI:1780831719
Name:AGRAWAL, KIREET (MD)
Entity Type:Individual
Prefix:DR
First Name:KIREET
Middle Name:
Last Name:AGRAWAL
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 1:5100 N MARINE DR APT 21B
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-3255
Mailing Address - Country:US
Mailing Address - Phone:410-294-8611
Mailing Address - Fax:
Practice Address - Street 1:3000 N HALSTED ST STE 611
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-5196
Practice Address - Country:US
Practice Address - Phone:708-797-8084
Practice Address - Fax:618-529-8707
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-21
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD.36022207R00000X
MDP22867207R00000X
IL036.132683207R00000X, 208M00000X
NH15646207R00000X
IL036132683207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist