Healthcare Provider Details

I. General information

NPI: 1548234073
Provider Name (Legal Business Name): NOORUN M KHAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2006
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 TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036096079
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036096079
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code207ZH0000X
TaxonomyHematology (Pathology) Physician
License Number036096079
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number036096079
License Number StateIL
# 5
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number036096079
License Number StateIL
# 6
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number036096079
License Number StateIL
# 7
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number036096079
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: