MEDICARE: DR. ALI AMIN KHAN M.D.

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	207R00000X	Internal Medicine Physician	2012025710	MO
2	207RP1001X	Pulmonary Disease Physician	036132695	IL
3	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	036132695	IL

General Provider Information

NPI Number	:	1326278417
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALI AMIN KHAN M.D.

Provider Business Mailing Address
First Line	:	1725 W HARRISON ST STE 54
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60612-3861
Country	:	US
Telephone Number	:	312-942-6744
Fax Number	:

Provider Business Practice Location Address
First Line	:	1725 W HARRISON ST STE 54
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60612-3861
Country	:	US
Telephone Number	:	312-942-6744
Fax Number	:

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

Provider Enumeration Date	:	07/22/2009
Last Update Date	:	04/16/2017

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