Healthcare Provider Details

I. General information

NPI: 1174713648
Provider Name (Legal Business Name): ATIKA T KHAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2007
Last Update Date: 10/30/2020
Certification Date: 10/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5145 N CALIFORNIA AVE STE M331M274
CHICAGO IL
60625-3661
US

IV. Provider business mailing address

2740 W FOSTER AVE STE 310
CHICAGO IL
60625-3547
US

V. Phone/Fax

Practice location:
  • Phone: 773-878-8200
  • Fax: 773-989-1734
Mailing address:
  • Phone: 773-878-8200
  • Fax: 773-293-8804

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number036118521
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036.118521
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: