Provider Demographics
NPI:1215984117
Name:KHANDEPARKER, REKHA VILAS (MD)
Entity type:Individual
Prefix:DR
First Name:REKHA
Middle Name:VILAS
Last Name:KHANDEPARKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-27
Last Update Date:2009-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036047940207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL36047939Medicaid
IL01635500OtherBLUECROSS BLUESHIELD
ILC42438Medicare UPIN