Healthcare Provider Details

I. General information

NPI: 1356802284
Provider Name (Legal Business Name): FARAH KHAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2019
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 N WESTMORELAND RD
LAKE FOREST IL
60045-1658
US

IV. Provider business mailing address

1000 N WESTMORELAND RD
LAKE FOREST IL
60045-1658
US

V. Phone/Fax

Practice location:
  • Phone: 847-535-7658
  • Fax: 847-535-7150
Mailing address:
  • Phone: 847-535-7658
  • Fax: 847-535-7150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084E0001X
TaxonomyEpilepsy Physician
License Number036164841
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number036.164841
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: