Provider Demographics
NPI:1730166455
Name:KHURANA, RAJ (MD)
Entity type:Individual
Prefix:DR
First Name:RAJ
Middle Name:
Last Name:KHURANA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1930 JESSICA LN
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-5876
Mailing Address - Country:US
Mailing Address - Phone:847-562-8606
Mailing Address - Fax:773-962-4632
Practice Address - Street 1:324 W 64TH ST
Practice Address - Street 2:SUITE 216
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60621-3118
Practice Address - Country:US
Practice Address - Phone:773-962-4183
Practice Address - Fax:773-962-4632
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036066235208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036066235Medicaid
IL698200Medicare ID - Type Unspecified
IL036066235Medicaid