Healthcare Provider Details

I. General information

NPI: 1790924488
Provider Name (Legal Business Name): KHURRAM RASHID M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/19/2009
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

804 W TRAILCREEK DR
PEORIA IL
61614-1862
US

IV. Provider business mailing address

804 W TRAILCREEK DR
PEORIA IL
61614-1862
US

V. Phone/Fax

Practice location:
  • Phone: 309-670-0700
  • Fax: 309-670-0703
Mailing address:
  • Phone: 309-670-0700
  • Fax: 309-670-0703

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number036127841
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number036127841
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: