Provider Demographics
NPI:1316192974
Name:NITIN KHER MD SC
Entity type:Organization
Organization Name:NITIN KHER MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NITIN
Authorized Official - Middle Name:
Authorized Official - Last Name:KHER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:815-307-8075
Mailing Address - Street 1:PO BOX 787
Mailing Address - Street 2:
Mailing Address - City:MCHENRY
Mailing Address - State:IL
Mailing Address - Zip Code:60051-9013
Mailing Address - Country:US
Mailing Address - Phone:224-238-4160
Mailing Address - Fax:847-214-9489
Practice Address - Street 1:690 E TERRA COTTA AVE STE A
Practice Address - Street 2:
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-3605
Practice Address - Country:US
Practice Address - Phone:815-307-8075
Practice Address - Fax:815-344-4302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-24
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036085008207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL5632380OtherBCBS PROV #
IL036085008Medicaid
ILDP2616OtherRAILROAD MEDICARE
ILIL1329Medicare PIN
IL036085008Medicaid
ILIL1328Medicare PIN