Healthcare Provider Details

I. General information

NPI: 1851413173
Provider Name (Legal Business Name): ANJUM KHAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 02/09/2024
Certification Date: 02/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5425 W BELMONT AVE
CHICAGO IL
60641-4127
US

IV. Provider business mailing address

1236 MCDANIELS AVE
HIGHLAND PARK IL
60035-3645
US

V. Phone/Fax

Practice location:
  • Phone: 312-702-1313
  • Fax:
Mailing address:
  • Phone: 312-813-6593
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number125.052236
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number4301502986
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMT188105
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number4301502986
License Number StateMI
# 5
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number036.125683
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: