MEDICARE: NORTHSTAR REHAB PAIN CLINICS PLLC

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	208100000X	Physical Medicine & Rehabilitation Physician

General Provider Information

NPI Number	:	1134863749
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHSTAR REHAB PAIN CLINICS PLLC

Provider Business Mailing Address
First Line	:	1236 MCDANIELS AVE
Second Line	:
City	:	HIGHLAND PARK
State	:	IL
Zip	:	60035-3645
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	131 E PARK AVE STE 103
Second Line	:
City	:	LIBERTYVILLE
State	:	IL
Zip	:	60048-2858
Country	:	US
Telephone Number	:	847-393-6246
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	ANJUM KHAN
Credential	:	MD
Telephone Number	:	312-813-6593

Provider Enumeration Date	:	04/21/2022
Last Update Date	:	01/29/2025

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