MEDICARE: DR. AYESHA KHAN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	036177883	IL
3	207R00000X	Internal Medicine Physician	125.082112	IL

General Provider Information

NPI Number	:	1043908551
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AYESHA KHAN MD

Provider Business Mailing Address
First Line	:	11600 S KEDZIE AVE STE D
Second Line	:
City	:	MERRIONETTE PARK
State	:	IL
Zip	:	60803-6307
Country	:	US
Telephone Number	:	708-684-6867
Fax Number	:	708-684-6869

Provider Business Practice Location Address
First Line	:	2525 S MICHIGAN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60616-2315
Country	:	US
Telephone Number	:	312-567-2000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/24/2023
Last Update Date	:	04/06/2026

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