Provider Demographics
NPI:1831122514
Name:DRS KHANNA & KHANNA LTD
Entity Type:Organization
Organization Name:DRS KHANNA & KHANNA LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MADELINE
Authorized Official - Middle Name:J
Authorized Official - Last Name:BEYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-888-3070
Mailing Address - Street 1:1425 N MCLEAN BLVD
Mailing Address - Street 2:STE 900
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123-5724
Mailing Address - Country:US
Mailing Address - Phone:847-888-3070
Mailing Address - Fax:847-888-0513
Practice Address - Street 1:1425 N MCLEAN BLVD
Practice Address - Street 2:STE 900
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-5724
Practice Address - Country:US
Practice Address - Phone:847-888-3070
Practice Address - Fax:847-888-0513
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2014-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036053069Medicaid
ILP00188818Medicare PIN
IL488590Medicare PIN
IL036053069Medicaid
IL488590Medicare PIN