Provider Demographics
NPI:1821443623
Name:KHIMANI, ANN (NP)
Entity Type:Individual
Prefix:MS
First Name:ANN
Middle Name:
Last Name:KHIMANI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:ANN
Other - Middle Name:L
Other - Last Name:BENDIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:2650 RIDGE AVE.
Mailing Address - Street 2:DEPARTMENT OF EMERGENCY MEDICINE
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201
Mailing Address - Country:US
Mailing Address - Phone:847-570-2114
Mailing Address - Fax:
Practice Address - Street 1:2650 RIDGE AVE.
Practice Address - Street 2:DEPARTMENT OF EMERGENCY MEDICINE
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201
Practice Address - Country:US
Practice Address - Phone:847-570-2114
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-28
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209013647041395610363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209013647OtherSTATE LICENSE
IL2015009621Medicaid
IL2015009621Medicare Oscar/Certification
IL2015009621Medicare PIN
IL2015009621Medicare NSC