Provider Demographics
NPI:1962401240
Name:REHAL, HARKAMAL K (MD)
Entity type:Individual
Prefix:DR
First Name:HARKAMAL
Middle Name:K
Last Name:REHAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:HARKAMAL
Other - Middle Name:K
Other - Last Name:SIDHU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4647 LINCOLN HWY
Mailing Address - Street 2:
Mailing Address - City:MATTESON
Mailing Address - State:IL
Mailing Address - Zip Code:60443-2319
Mailing Address - Country:US
Mailing Address - Phone:708-747-5850
Mailing Address - Fax:708-747-9991
Practice Address - Street 1:71 W 156TH ST
Practice Address - Street 2:SUITE 305
Practice Address - City:HARVEY
Practice Address - State:IL
Practice Address - Zip Code:60426-4260
Practice Address - Country:US
Practice Address - Phone:708-333-3113
Practice Address - Fax:708-333-8991
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2009-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036111337207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036111337Medicaid
IL3160176976OtherBLUE SHIELD
363705401OtherEIN
ILK08922Medicare PIN
IL911220Medicare PIN
IL594180Medicare PIN
ILCC3938Medicare PIN
ILI14483Medicare UPIN
IL3160176976OtherBLUE SHIELD
ILP00179181Medicare PIN