Provider Demographics
NPI:1750389953
Name:KHEMANI, ANIL K (MD)
Entity type:Individual
Prefix:
First Name:ANIL
Middle Name:K
Last Name:KHEMANI
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 1:2000 LAKE AVE
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:IL
Mailing Address - Zip Code:60098-7401
Mailing Address - Country:US
Mailing Address - Phone:815-337-7100
Mailing Address - Fax:815-337-4700
Practice Address - Street 1:2000 LAKE AVE
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:IL
Practice Address - Zip Code:60098-7401
Practice Address - Country:US
Practice Address - Phone:815-337-7100
Practice Address - Fax:815-337-4700
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2012-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036091226207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036091226 4Medicaid
IL05620217OtherBLUE CROSS BLUE SHIELD
IL036091226Medicaid
WI99111244Medicaid
WIKHEMAANIOtherMERCYCARE INSURANCE
WI1750389953Medicaid
ILE99601Medicare UPIN
IL036091226Medicaid
IL981950Medicare PIN
WIKHEMAANIOtherMERCYCARE INSURANCE
ILL88403Medicare PIN
IL05620217OtherBLUE CROSS BLUE SHIELD
IL981960Medicare PIN