Healthcare Provider Details

I. General information

NPI: 1033200985
Provider Name (Legal Business Name): REZWAN U KHAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 10/28/2025
Certification Date: 10/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 E MAIN ST
DANVILLE IL
61832-5100
US

IV. Provider business mailing address

8842 BROWNS VALLEY LN
CAMBY IN
46113-8821
US

V. Phone/Fax

Practice location:
  • Phone: 217-554-5383
  • Fax:
Mailing address:
  • Phone: 317-856-9886
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberT5358
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number4301098822
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: