Healthcare Provider Details

I. General information

NPI: 1427467703
Provider Name (Legal Business Name): SAMEER KHAN DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2014
Last Update Date: 07/18/2025
Certification Date: 07/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6326 CERMAK RD
BERWYN IL
60402-2304
US

IV. Provider business mailing address

6326 CERMAK RD
BERWYN IL
60402-2304
US

V. Phone/Fax

Practice location:
  • Phone: 708-303-9234
  • Fax: 773-729-2074
Mailing address:
  • Phone: 708-303-9234
  • Fax: 773-729-2074

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number016005804
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberR93661
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number966
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: