Individual
DR. ALLY-KHAN B SOMANI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D., PH.D.
Contact information
Practice address
16105 S LA GRANGE RD, ORLAND PARK, IL 60467-5503
(708) 636-3767
(708) 873-5849
Mailing address
250 N SHADELAND AVE, STE 130 PROVIDER ENROLLMENT, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
01066254A
IN
207N00000X
Dermatology Physician
Primary
036149454
IL
207N00000X
Dermatology Physician
35.091501
OH
207ND0101X
MOHS-Micrographic Surgery Physician
01066254A
IN
207ND0101X
MOHS-Micrographic Surgery Physician
036149454
IL
207NS0135X
Procedural Dermatology Physician
01066254A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200945370
—
IN
Enumeration date
05/24/2007
Last updated
07/25/2023
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