Provider Demographics
NPI:1851390348
Name:KOHLI, MANINDER S (MD)
Entity Type:Individual
Prefix:
First Name:MANINDER
Middle Name:S
Last Name:KOHLI
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 1:950 N YORK RD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-2950
Mailing Address - Country:US
Mailing Address - Phone:630-590-5751
Mailing Address - Fax:630-590-5753
Practice Address - Street 1:950 N YORK RD
Practice Address - Street 2:SUITE 205
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-2950
Practice Address - Country:US
Practice Address - Phone:630-590-5751
Practice Address - Fax:630-590-5753
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2012-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036092528207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036092528Medicaid
ILIL1717001Medicare PIN
IL210183Medicare PIN
IL036092528Medicaid
ILIL2014001Medicare PIN
ILDD3356Medicare PIN
ILH47288Medicare UPIN
ILIL2014Medicare PIN
ILK11576Medicare PIN
ILP00221907Medicare PIN