Healthcare Provider Details

I. General information

NPI: 1639158777
Provider Name (Legal Business Name): KHURRAM QADIR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2006
Last Update Date: 10/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1315 N HIGHLAND AVE STE 105
AURORA IL
60506-1400
US

IV. Provider business mailing address

1315 N HIGHLAND AVE STE 105
AURORA IL
60506-1400
US

V. Phone/Fax

Practice location:
  • Phone: 630-906-9700
  • Fax: 630-859-2378
Mailing address:
  • Phone: 630-906-9700
  • Fax: 630-859-2378

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number036114031
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: