Provider Demographics
NPI:1215176557
Name:MPS KOHLI MD SC
Entity type:Organization
Organization Name:MPS KOHLI MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MANINDER
Authorized Official - Middle Name:S
Authorized Official - Last Name:KOHLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-590-5751
Mailing Address - Street 1:950 N YORK RD STE 205
Mailing Address - Street 2:
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-8609
Mailing Address - Country:US
Mailing Address - Phone:630-590-5751
Mailing Address - Fax:630-590-5753
Practice Address - Street 1:950 N YORK RD
Practice Address - Street 2:SUITE 205
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521
Practice Address - Country:US
Practice Address - Phone:630-590-5751
Practice Address - Fax:630-590-5753
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-10
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036092528207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036092528Medicaid
IL2234079OtherBLUE CROSS BLUE SHIELD
IL036092528Medicaid
ILIL2014Medicare PIN
IL2234079OtherBLUE CROSS BLUE SHIELD