Provider Demographics
NPI:1427050327
Name:KHURANA, DEEPAK (MD)
Entity type:Individual
Prefix:
First Name:DEEPAK
Middle Name:
Last Name:KHURANA
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 1:1710 N RANDALL RD
Mailing Address - Street 2:SUITE 280
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123-9400
Mailing Address - Country:US
Mailing Address - Phone:847-931-7550
Mailing Address - Fax:847-931-0876
Practice Address - Street 1:1710 N RANDALL RD
Practice Address - Street 2:SUITE 280
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-9400
Practice Address - Country:US
Practice Address - Phone:847-931-7550
Practice Address - Fax:847-931-0876
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2019-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-057728174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0360577282Medicaid
IL100000663OtherMEDICARE RAILROAD
IL0360577282Medicaid
ILK27124Medicare ID - Type UnspecifiedINDIVIDUAL PROVIDER ID