Provider Demographics
NPI:1013124932
Name:KHERDEKAR, ANJALI SUBHASH (MD)
Entity type:Individual
Prefix:DR
First Name:ANJALI
Middle Name:SUBHASH
Last Name:KHERDEKAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3210 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:WAUKEGAN
Mailing Address - State:IL
Mailing Address - Zip Code:60085-2204
Mailing Address - Country:US
Mailing Address - Phone:806-353-7417
Mailing Address - Fax:806-353-4007
Practice Address - Street 1:12 CARE CIR
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79124-2118
Practice Address - Country:US
Practice Address - Phone:806-353-7417
Practice Address - Fax:806-353-4007
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2019-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036099539207R00000X
TXM6230207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine