Healthcare Provider Details

I. General information

NPI: 1922488808
Provider Name (Legal Business Name): MIRZA SAMIUDDIN KHAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2015
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2150 PFINGSTEN RD STE 1200
GLENVIEW IL
60026-1326
US

IV. Provider business mailing address

4901 SEARLE PKWY STE 150
SKOKIE IL
60077-5320
US

V. Phone/Fax

Practice location:
  • Phone: 847-657-1819
  • Fax:
Mailing address:
  • Phone: 847-570-2040
  • Fax: 847-982-3394

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2022010401
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number036177817
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036177817
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: