Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0200X | Critical Care Medicine | 036132687 | IL |
Y | 207RP1001X | Pulmonary Disease | 036132687 | IL |
N | 207RS0012X | Sleep Medicine | 036132687 | IL |
NPI | 1053629881 |
---|---|
Provider Name | Dr. Samrat Umesh Khanna |
First Address | Kankakee, IL 60901-2942 |
Second Address | Kankakee, IL 60901-2942 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/09/2010 |
Last Update Date | 22/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036132687 | (05) | IL |