Healthcare Provider Details

I. General information

NPI: 1194642140
Provider Name (Legal Business Name): BILAL KHAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2026
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

190 GARDNER AVE STE 5
BURLINGTON WI
53105-2160
US

IV. Provider business mailing address

432 RED OAK CIR
FOX LAKE IL
60020-3227
US

V. Phone/Fax

Practice location:
  • Phone: 262-763-6921
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number6002237-15
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: