Healthcare Provider Details

I. General information

NPI: 1245736636
Provider Name (Legal Business Name): MUHAMMAD ALI KHAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2018
Last Update Date: 09/27/2021
Certification Date: 09/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1875 W DEMPSTER ST STE 525
PARK RIDGE IL
60068-1130
US

IV. Provider business mailing address

5 ELM CREEK DR APT 404
ELMHURST IL
60126-5292
US

V. Phone/Fax

Practice location:
  • Phone: 847-698-3600
  • Fax:
Mailing address:
  • Phone: 312-871-7461
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number03692933
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: