Healthcare Provider Details

I. General information

NPI: 1861797276
Provider Name (Legal Business Name): FAROOQ HASSAN KHAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/14/2011
Last Update Date: 10/22/2025
Certification Date: 10/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20201 CRAWFORD AVE
OLYMPIA FIELDS IL
60461-1010
US

IV. Provider business mailing address

204 BRIDLE PATH CIR
OAK BROOK IL
60523-2615
US

V. Phone/Fax

Practice location:
  • Phone: 844-740-4445
  • Fax: 708-679-2161
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036142933
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number036142933
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: