Provider Demographics
NPI:1821441619
Name:KHATRI, KAMRAN
Entity Type:Individual
Prefix:
First Name:KAMRAN
Middle Name:
Last Name:KHATRI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 ROSEDALE RD
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60025-3951
Mailing Address - Country:US
Mailing Address - Phone:847-932-9558
Mailing Address - Fax:
Practice Address - Street 1:6319 FAIRVIEW AVE STE 101
Practice Address - Street 2:
Practice Address - City:WESTMONT
Practice Address - State:IL
Practice Address - Zip Code:60559-2889
Practice Address - Country:US
Practice Address - Phone:630-451-9352
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-18
Last Update Date:2017-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209014492363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily