Provider Demographics
NPI:1710004627
Name:SIKANDER, MANSOOR KAMAL (OTR)
Entity type:Individual
Prefix:MR
First Name:MANSOOR
Middle Name:KAMAL
Last Name:SIKANDER
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2843 WINDSOR DR APT 109
Mailing Address - Street 2:
Mailing Address - City:LISLE
Mailing Address - State:IL
Mailing Address - Zip Code:60532-6203
Mailing Address - Country:US
Mailing Address - Phone:630-207-1176
Mailing Address - Fax:
Practice Address - Street 1:2323 MCDANIEL AVE
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-2549
Practice Address - Country:US
Practice Address - Phone:630-207-1176
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-24
Last Update Date:2025-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160003627225200000X
IL056009090225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant