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General NPI Number Information
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NPI Number | 1669430567
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Entity Type | Individual
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Provider Name | FAZAL KHAN M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/02/2006
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Last Update Date | 04/24/2009
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Provider Practice Location Address
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Address Line | 10350 HALIGUS RD
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City | HUNTLEY
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State | IL
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Zip | 60142-9558
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Country | US
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Telephone | 815-338-6600
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Fax | 847-802-7203
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Provider Business Mailing Address
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Address Line | 13707 W JACKSON ST
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City | WOODSTOCK
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State | IL
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Zip | 60098-3188
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Country | US
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Telephone | 815-337-1871
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Fax | 815-338-6297
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 036104590
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License Number State | IL
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