Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 036053069 | IL |
NPI | 1023005881 |
---|---|
Provider Name | Ramesh R Khanna |
First Address | Elgin, IL 60123-5724 |
Second Address | Elgin, IL 60123-5724 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2005 |
Last Update Date | 29/05/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036053069 | (05) | IL |
D13022 | (02) | IL |