Provider Demographics
NPI:1942394499
Name:KINGRA, SATWANT (MD)
Entity Type:Individual
Prefix:
First Name:SATWANT
Middle Name:
Last Name:KINGRA
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 1:2733 W 87TH ST
Mailing Address - Street 2:
Mailing Address - City:EVERGREEN PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60805-1104
Mailing Address - Country:US
Mailing Address - Phone:708-424-1153
Mailing Address - Fax:
Practice Address - Street 1:2733 W 87TH ST
Practice Address - Street 2:
Practice Address - City:EVERGREEN PARK
Practice Address - State:IL
Practice Address - Zip Code:60805-1104
Practice Address - Country:US
Practice Address - Phone:708-424-1153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2017-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036086600207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1605563OtherBLUE CROSS BLUE SHIELD
IL036086600Medicaid
IL531330Medicare ID - Type Unspecified
ILF85706Medicare UPIN