MEDICARE: MILLENNIUM PARK MEDICAL ASSOCIATES, S.C.

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	261Q00000X	Clinic/Center	036103943	IL

General Provider Information

NPI Number	:	1700073780
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MILLENNIUM PARK MEDICAL ASSOCIATES, S.C.

Provider Business Mailing Address
First Line	:	30 S MICHIGAN AVE
Second Line	:	SUITE #500
City	:	CHICAGO
State	:	IL
Zip	:	60603-3211
Country	:	US
Telephone Number	:	312-977-1185
Fax Number	:	312-977-1188

Provider Business Practice Location Address
First Line	:	30 S MICHIGAN AVE STE 500
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60603-3205
Country	:	US
Telephone Number	:	312-977-1185
Fax Number	:	312-977-1188

Authorized Official
Title or Position	:	OWNER, CEO
Name	:	DR. FARAH N KHAN
Credential	:	M.D., F.A.C.P.
Telephone Number	:	312-977-1185

Provider Enumeration Date	:	10/03/2007
Last Update Date	:	10/18/2023

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