Healthcare Provider Details

I. General information

NPI: 1922446186
Provider Name (Legal Business Name): SARAH M KHAN D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2013
Last Update Date: 09/29/2022
Certification Date: 09/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 W NORTH AVE FL 1
CHICAGO IL
60610-1042
US

IV. Provider business mailing address

711 W NORTH AVE FL 1
CHICAGO IL
60610-1042
US

V. Phone/Fax

Practice location:
  • Phone: 312-337-1982
  • Fax:
Mailing address:
  • Phone: 312-337-1982
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036139362
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: