| Nandra Family Practice, Ltd. | |
|
115 E South St Unit F Plano IL 60545-1417 | |
| (630) 552-7166 | |
| (630) 552-7168 |
| Full Name | Nandra Family Practice, Ltd. |
|---|---|
| Speciality | Family Medicine |
| Location | 115 E South St, Plano, Illinois |
| Authorized Official Name and Position | Mukhtar S Nandra (PRESIDENT) |
| Authorized Official Contact | 6305527166 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Nandra Family Practice, Ltd. 115 E South St Unit F Plano IL 60545-1417 Ph: (630) 552-7166 | Nandra Family Practice, Ltd. 115 E South St Unit F Plano IL 60545-1417 Ph: (630) 552-7166 |
| NPI Number | 1629203534 |
|---|---|
| Provider Enumeration Date | 05/20/2009 |
| Last Update Date | 05/20/2009 |
| Medicare PECOS PAC ID | 7315092673 |
|---|---|
| Medicare Enrollment ID | O20090910000219 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629203534 | NPI | - | NPPES |
| 1639358427 | Other | IL | NPI |
| 036-083629 | Medicaid | IL | |
| 1942373931 | Other | NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 036-083629 (Illinois) | Primary |
| 207R00000X | Internal Medicine | 036-119568 (Illinois) | Secondary |
| Provider Name | Mukhtar S Nandra |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1942373931 PECOS PAC ID: 0648173070 Enrollment ID: I20040131000232 |
| Provider Name | Ravinderpal Nandra |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1639358427 PECOS PAC ID: 7911052162 Enrollment ID: I20090911000340 |
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