Healthcare Provider Details

I. General information

NPI: 1477414662
Provider Name (Legal Business Name): KHALIL FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2025
Last Update Date: 11/19/2025
Certification Date: 11/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1946 DAIMLER RD
ROCKFORD IL
61112-1008
US

IV. Provider business mailing address

998 N LOMBARD RD
LOMBARD IL
60148-1264
US

V. Phone/Fax

Practice location:
  • Phone: 855-554-2545
  • Fax:
Mailing address:
  • Phone: 855-554-2545
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: MOHSIN KHAN KHAN
Title or Position: OWNER/MANAGING PARTNER
Credential: MD
Phone: 815-980-9416