1205000924 NPI number — MANALI DOSHI KALRA MD

Table of content: MANALI DOSHI KALRA MD (NPI 1205000924)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205000924 NPI number — MANALI DOSHI KALRA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KALRA
Provider First Name:
MANALI
Provider Middle Name:
DOSHI
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DOSHI
Provider Other First Name:
MANALI
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1205000924
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/23/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1123 W GRACE ST
Provider Second Line Business Mailing Address:
#3E
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60613-3250
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3001 GREEN BAY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60064-3048
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
224-610-7151
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/14/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  036.123163 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 205785 . This is a "ESC GROUP MEDICARE COOK CO" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 205786 . This is a "ESC GROUP MEDICARE DUPAGE CO" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 1083684922 . This is a "THE EYE SPECIALIST CENTER, LLC GRP NPI" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 1699802421 . This is a "ESC OPTICAL GRP NPI NUMBER" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 2057850055 . This is a "INDIVIDUAL PTAN" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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