Provider Demographics
NPI:1265570311
Name:AKHAND, MANJU M (MD)
Entity type:Individual
Prefix:DR
First Name:MANJU
Middle Name:M
Last Name:AKHAND
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MANJU
Other - Middle Name:
Other - Last Name:MALHOTRA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:391 QUADRANGLE DR
Mailing Address - Street 2:SUITE N2
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-3442
Mailing Address - Country:US
Mailing Address - Phone:630-679-1275
Mailing Address - Fax:630-679-1276
Practice Address - Street 1:391 QUADRANGLE DR
Practice Address - Street 2:SUITE N2
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60440-3442
Practice Address - Country:US
Practice Address - Phone:630-679-1275
Practice Address - Fax:630-679-1276
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-099220208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036099220Medicaid
H76814Medicare UPIN