Healthcare Provider Details

I. General information

NPI: 1376667816
Provider Name (Legal Business Name): NAIMATH A KHAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 08/17/2021
Certification Date: 08/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8420 W BRYN MAWR AVE STE 300
CHICAGO IL
60631-3479
US

IV. Provider business mailing address

PO BOX 443
BEDFORD PARK IL
60499-0443
US

V. Phone/Fax

Practice location:
  • Phone: 773-355-5300
  • Fax:
Mailing address:
  • Phone: 773-355-5300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number036113976
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number036-113976
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: