Provider Demographics
NPI:1821220625
Name:KHUSHI JENNA PARTNERSHIP, LLC
Entity Type:Organization
Organization Name:KHUSHI JENNA PARTNERSHIP, LLC
Other - Org Name:SUBURBAN MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RITESH
Authorized Official - Middle Name:D
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-995-9500
Mailing Address - Street 1:800 E WOODFIELD RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60173-4780
Mailing Address - Country:US
Mailing Address - Phone:847-995-9500
Mailing Address - Fax:847-995-9501
Practice Address - Street 1:800 E WOODFIELD RD
Practice Address - Street 2:SUITE 102
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60173-4780
Practice Address - Country:US
Practice Address - Phone:847-995-9500
Practice Address - Fax:847-995-9501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-13
Last Update Date:2016-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036115260207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036115260Medicaid
ILIL2564Medicare PIN
IL036115260Medicaid