Provider Demographics
NPI:1215058656
Name:KHANDEPARKER, SC.
Entity type:Organization
Organization Name:KHANDEPARKER, SC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VILAS
Authorized Official - Middle Name:
Authorized Official - Last Name:KHANDEPARKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-581-5888
Mailing Address - Street 1:6084 S ARCHER AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60638-2747
Mailing Address - Country:US
Mailing Address - Phone:773-581-5888
Mailing Address - Fax:773-581-5895
Practice Address - Street 1:6084 S ARCHER AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60638-2747
Practice Address - Country:US
Practice Address - Phone:773-581-5888
Practice Address - Fax:773-581-5895
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036047939207RH0003X
IL036047940208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL211708Medicare ID - Type Unspecified
ILC42438Medicare UPIN
ILD12029Medicare UPIN