Healthcare Provider Details

I. General information

NPI: 1306253349
Provider Name (Legal Business Name): SALMAN ALI KHAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2014
Last Update Date: 05/14/2025
Certification Date: 05/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4309 W MEDICAL CENTER DR STE B301
MCHENRY IL
60050-8439
US

IV. Provider business mailing address

4309 W MEDICAL CENTER DR STE B301
MCHENRY IL
60050-8439
US

V. Phone/Fax

Practice location:
  • Phone: 847-535-6083
  • Fax: 847-234-4336
Mailing address:
  • Phone: 847-535-6083
  • Fax: 847-234-4336

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberMD-47761
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number2014016485
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number036168575
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: