Healthcare Provider Details

I. General information

NPI: 1164636585
Provider Name (Legal Business Name): N M KHAN M D S C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 06/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7600 W COLLEGE DR 2ND FLOOR
PALOS HEIGHTS IL
60463-1001
US

IV. Provider business mailing address

PO BOX 393
WORTH IL
60482-0393
US

V. Phone/Fax

Practice location:
  • Phone: 708-671-1800
  • Fax: 708-671-1803
Mailing address:
  • Phone: 630-551-1097
  • Fax: 630-551-1097

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: NOORUN KHAN
Title or Position: OWNER
Credential: MD
Phone: 630-244-2841