MEDICARE: DR. MOHAMMAD H 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	207RG0100X	Gastroenterology Physician	036090466	IL
2	207RG0100X	Gastroenterology Physician	01063260A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1396810370
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MOHAMMAD H KHAN MD

Provider Business Mailing Address
First Line	:	474 NORTH LAKE SHORE DRIVE
Second Line	:	APT 4510
City	:	CHICAGO
State	:	IL
Zip	:	60611-6488
Country	:	US
Telephone Number	:	312-224-8764
Fax Number	:

Provider Business Practice Location Address
First Line	:	474 NORTH LAKE SHORE DRIVE
Second Line	:	APT 4510
City	:	CHICAGO
State	:	IL
Zip	:	60611-6488
Country	:	US
Telephone Number	:	312-224-8764
Fax Number	:

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

Provider Enumeration Date	:	11/22/2006
Last Update Date	:	09/14/2020

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