Provider Demographics
NPI:1902954381
Name:THUKRAL, ANJALI (MD)
Entity Type:Individual
Prefix:
First Name:ANJALI
Middle Name:
Last Name:THUKRAL
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:PO BOX 2190
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-1085
Mailing Address - Country:US
Mailing Address - Phone:708-799-6450
Mailing Address - Fax:708-799-6560
Practice Address - Street 1:17901 GOVERNORS HWY
Practice Address - Street 2:SUITE 103
Practice Address - City:HOMEWOOD
Practice Address - State:IL
Practice Address - Zip Code:60430-1144
Practice Address - Country:US
Practice Address - Phone:708-799-6450
Practice Address - Fax:708-799-6560
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2020-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036109201207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL562436825OtherWOMENS HEALTHCARE ASSOCIATES OF IL SC
IL562436825OtherWOMENS HEALTHCARE ASSOCIATES OF IL SC