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General NPI Number Information
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NPI Number | 1700073780
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Entity Type | Organization
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Legal Business Name | MILLENNIUM PARK MEDICAL ASSOCIATES, S.C.
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Dates
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Enumeration Date | 10/03/2007
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Last Update Date | 10/18/2023
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Provider Practice Location Address
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Address Line | 30 S MICHIGAN AVE STE 500
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City | CHICAGO
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State | IL
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Zip | 60603-3205
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Country | US
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Telephone | 312-977-1185
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Fax | 312-977-1188
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Provider Business Mailing Address
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Address Line | 30 S MICHIGAN AVE SUITE #500
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City | CHICAGO
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State | IL
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Zip | 60603-3211
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Country | US
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Telephone | 312-977-1185
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Fax | 312-977-1188
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Authorized Official
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Title or Position | OWNER, CEO
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Name | DR. FARAH N KHAN
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Credential | M.D., F.A.C.P.
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Telephone | 312-977-1185
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 036103943
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License Number State | IL
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