Provider Demographics
NPI:1447308176
Name:KEY INTERNAL MEDICINE, S.C.
Entity type:Organization
Organization Name:KEY INTERNAL MEDICINE, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DHARAM
Authorized Official - Middle Name:R
Authorized Official - Last Name:ANAND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:815-932-9210
Mailing Address - Street 1:PO BOX 715
Mailing Address - Street 2:
Mailing Address - City:BOURBONNAIS
Mailing Address - State:IL
Mailing Address - Zip Code:60914-0715
Mailing Address - Country:US
Mailing Address - Phone:815-932-9210
Mailing Address - Fax:815-932-9220
Practice Address - Street 1:100 PROVENA WAY STE D
Practice Address - Street 2:
Practice Address - City:BOURBONNAIS
Practice Address - State:IL
Practice Address - Zip Code:60914
Practice Address - Country:US
Practice Address - Phone:815-932-9210
Practice Address - Fax:815-932-9220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-076865207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL4632036OtherBCBS PROVIDER NUMBER
IL036076865Medicaid
ILK02212Medicare PIN
IL4632036OtherBCBS PROVIDER NUMBER