Provider Demographics
NPI:1255454625
Name:KISHORE LAKHANI MDSC
Entity type:Organization
Organization Name:KISHORE LAKHANI MDSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLER
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:B
Authorized Official - Last Name:HESTER
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:773-827-7000
Mailing Address - Street 1:PO BOX 696
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60108-0696
Mailing Address - Country:US
Mailing Address - Phone:847-882-6060
Mailing Address - Fax:847-882-6061
Practice Address - Street 1:2500 WEST HIGGINS ROAD
Practice Address - Street 2:SUITE 330
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60169-7207
Practice Address - Country:US
Practice Address - Phone:847-882-6060
Practice Address - Fax:847-882-6061
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2011-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036061273207VX0000X, 207V00000X
IL36061273207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036061273Medicaid
IL2201417OtherBLUE SHIELD #
IL2201417OtherBLUE SHIELD #
ILC45629Medicare UPIN
IL688070Medicare ID - Type UnspecifiedMEDICARE #
IL2201417Medicare PIN