Healthcare Provider Details

I. General information

NPI: 1356316715
Provider Name (Legal Business Name): ZAHANGIR KHALED MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2006
Last Update Date: 12/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 N 8TH ST SUITE PAV 4A
SPRINGFIELD IL
62701-1041
US

IV. Provider business mailing address

PO BOX 19658
SPRINGFIELD IL
62794-9658
US

V. Phone/Fax

Practice location:
  • Phone: 217-545-8000
  • Fax: 217-545-8840
Mailing address:
  • Phone: 217-545-8000
  • Fax: 217-545-8840

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number036105305
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: