Healthcare Provider Details

I. General information

NPI: 1760593693
Provider Name (Legal Business Name): FARHAN A KHAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1036 W STEPHENSON ST
FREEPORT IL
61032-4865
US

IV. Provider business mailing address

1045 W STEPHENSON ST
FREEPORT IL
61032-4864
US

V. Phone/Fax

Practice location:
  • Phone: 815-599-6000
  • Fax:
Mailing address:
  • Phone: 815-599-6000
  • Fax: 815-599-7974

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number036113057
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036113057
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number036113057
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: