Provider Demographics
NPI:1851916100
Name:KHANAL, SMRITI (MD)
Entity type:Individual
Prefix:
First Name:SMRITI
Middle Name:
Last Name:KHANAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 LYONS AVE STE C2
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07112-2027
Mailing Address - Country:US
Mailing Address - Phone:872-227-7180
Mailing Address - Fax:312-864-9725
Practice Address - Street 1:1950 W POLK STREET
Practice Address - Street 2:6TH FLOOR, #150
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3723
Practice Address - Country:US
Practice Address - Phone:872-227-7180
Practice Address - Fax:312-864-9725
Is Sole Proprietor?:No
Enumeration Date:2020-06-12
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125.076624390200000X
NJ25MA12125700390200000X
IL125076624390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program