Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 036121277 | IL |
NPI | 1720273378 |
---|---|
Provider Name | Dr. Sanjay Pradeep Keni |
First Address | Palos Heights, IL 60463-2269 |
Second Address | Palos Heights, IL 60463-2269 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/09/2007 |
Last Update Date | 16/07/2020 |