Provider Demographics
NPI:1760061469
Name:KOLLI, HIREN (MD)
Entity type:Individual
Prefix:DR
First Name:HIREN
Middle Name:
Last Name:KOLLI
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 1:2650 RIDGE AVE STE 1223
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-1700
Mailing Address - Country:US
Mailing Address - Phone:847-982-3172
Mailing Address - Fax:
Practice Address - Street 1:3122 N. ASHLAND AVE.
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-3014
Practice Address - Country:US
Practice Address - Phone:847-663-8060
Practice Address - Fax:773-687-7795
Is Sole Proprietor?:No
Enumeration Date:2021-04-08
Last Update Date:2025-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036175706207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology