Healthcare Provider Details

I. General information

NPI: 1003741521
Provider Name (Legal Business Name): B M KHAN DO PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13011 S 104TH AVE STE 203
PALOS PARK IL
60464-1512
US

IV. Provider business mailing address

13011 S 104TH AVE STE 203
PALOS PARK IL
60464-1512
US

V. Phone/Fax

Practice location:
  • Phone: 703-964-8199
  • Fax: 703-649-6188
Mailing address:
  • Phone: 703-964-8199
  • Fax: 703-649-6188

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. BAASMA KHAN
Title or Position: PRESIDENT
Credential: DO
Phone: 703-964-8199