Provider Demographics
NPI:1306899570
Name:KHOSLA, KRISHDEEP (MD)
Entity type:Individual
Prefix:
First Name:KRISHDEEP
Middle Name:
Last Name:KHOSLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8625 TIMBER RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:BURR RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60527-5694
Mailing Address - Country:US
Mailing Address - Phone:630-953-9009
Mailing Address - Fax:
Practice Address - Street 1:1 S 376 SUMMIT AVE
Practice Address - Street 2:COURT C UNIT 4-B
Practice Address - City:OAKBROOK TERRACE
Practice Address - State:IL
Practice Address - Zip Code:60181
Practice Address - Country:US
Practice Address - Phone:773-257-6770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-18
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-099607207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILG93887Medicare UPIN