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General NPI Number Information
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NPI Number | 1295940724
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Entity Type | Individual
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Provider Name | OSMAAN ABBAS KHAWAJA MD
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Gender | Male
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Dates
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Enumeration Date | 05/10/2007
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Last Update Date | 08/07/2007
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Provider Practice Location Address
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Address Line | 215 E 1ST ST SUITE 105
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City | DIXON
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State | IL
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Zip | 61021-3166
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Country | US
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Telephone | 815-285-5842
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Fax | 815-285-5845
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Provider Business Mailing Address
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Address Line | 215 E 1ST ST SUITE 105
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City | DIXON
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State | IL
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Zip | 61021-3166
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Country | US
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Telephone | 815-285-5842
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Fax | 815-285-5845
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 2086S0102X
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Taxonomy Name | Surgical Critical Care Physician
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License Number |
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 2086S0127X
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Taxonomy Name | Trauma Surgery Physician
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License Number |
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License Number State | IL
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