Provider Demographics
NPI:1104935600
Name:KHANNA, MANISHA SARAF (MD)
Entity type:Individual
Prefix:DR
First Name:MANISHA
Middle Name:SARAF
Last Name:KHANNA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MANISHA
Other - Middle Name:ARVIND
Other - Last Name:SARAF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:535 S WASHINGTON ST
Mailing Address - Street 2:STE 22
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-6795
Mailing Address - Country:US
Mailing Address - Phone:630-810-0451
Mailing Address - Fax:877-446-3870
Practice Address - Street 1:535 S WASHINGTON ST
Practice Address - Street 2:STE 22
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-6795
Practice Address - Country:US
Practice Address - Phone:630-810-0451
Practice Address - Fax:877-446-3870
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2011-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36112316208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK19351Medicare PIN
I35764Medicare UPIN