Healthcare Provider Details

I. General information

NPI: 1659396497
Provider Name (Legal Business Name): FAISAL Q. KHAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 06/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 RANDALL RD. CADENCE PHYSICIAN GROUP
GENEVA IL
60134-4220
US

IV. Provider business mailing address

302 RANDALL RD CADENCE PHYSICIAN GROUP
GENEVA IL
60134-4220
US

V. Phone/Fax

Practice location:
  • Phone: 630-262-7400
  • Fax: 630-262-3760
Mailing address:
  • Phone: 630-262-7400
  • Fax: 630-262-3760

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301081794
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number036135009
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: