Healthcare Provider Details

I. General information

NPI: 1942717418
Provider Name (Legal Business Name): MADIHA KHAN DNP, APRN, FNP-BC,
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DIA KHAN DNP, APRN

II. Dates (important events)

Enumeration Date: 01/05/2018
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2233 W DIVISION ST
CHICAGO IL
60622-8151
US

IV. Provider business mailing address

701 W NORTH AVE
MELROSE PARK IL
60160-1612
US

V. Phone/Fax

Practice location:
  • Phone: 224-678-8760
  • Fax:
Mailing address:
  • Phone: 708-681-3200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209017257
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number209017257
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: