Healthcare Provider Details

I. General information

NPI: 1497575526
Provider Name (Legal Business Name): HARIS KHAN PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/14/2024
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16650 HARLEM AVE
TINLEY PARK IL
60477-2582
US

IV. Provider business mailing address

713 GRANT CIR
HANOVER PARK IL
60133-2773
US

V. Phone/Fax

Practice location:
  • Phone: 708-802-9355
  • Fax:
Mailing address:
  • Phone: 630-940-6217
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: