Healthcare Provider Details

I. General information

NPI: 1649195397
Provider Name (Legal Business Name): HAROON RASHEED KHAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5542 W FOND DU LAC AVE
MILWAUKEE WI
53216-1200
US

IV. Provider business mailing address

18954 W NORTH WOODALE TRL
LAKE VILLA IL
60046-1712
US

V. Phone/Fax

Practice location:
  • Phone: 414-240-0935
  • Fax:
Mailing address:
  • Phone: 847-530-8180
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number019.037165
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number6002308
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: