Provider Demographics
NPI:1164756920
Name:KAMBOJ, MUKESH KUMAR (MD)
Entity type:Individual
Prefix:
First Name:MUKESH
Middle Name:KUMAR
Last Name:KAMBOJ
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 1:1200 W ALGONQUIN RD BLDG M
Mailing Address - Street 2:
Mailing Address - City:PALATINE
Mailing Address - State:IL
Mailing Address - Zip Code:60067-7373
Mailing Address - Country:US
Mailing Address - Phone:847-618-0121
Mailing Address - Fax:847-618-0134
Practice Address - Street 1:1200 W ALGONQUIN RD BLDG M
Practice Address - Street 2:
Practice Address - City:PALATINE
Practice Address - State:IL
Practice Address - Zip Code:60067-7373
Practice Address - Country:US
Practice Address - Phone:847-618-0121
Practice Address - Fax:847-618-0134
Is Sole Proprietor?:No
Enumeration Date:2009-09-28
Last Update Date:2022-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK27283207Q00000X
IA40224207Q00000X
IL036.131133207QB0002X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QB0002XAllopathic & Osteopathic PhysiciansFamily MedicineObesity Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036131133OtherSTATE LICENSE