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General NPI Number Information
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NPI Number | 1952642126
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Entity Type | Individual
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Provider Name | SHAEMAH KHAN D.O.
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Gender | Female
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Dates
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Enumeration Date | 03/12/2013
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Last Update Date | 10/01/2019
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Provider Practice Location Address
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Address Line | 635 N DEARBORN ST STE 100
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City | CHICAGO
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State | IL
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Zip | 60654-4618
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Country | US
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Telephone | 312-694-2273
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Fax |
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Provider Business Mailing Address
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Address Line | 1550 S BLUE ISLAND AVE UNIT 1118
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City | CHICAGO
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State | IL
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Zip | 60608-2939
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Country | US
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Telephone | 630-398-1322
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Fax |
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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 | 036139817
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License Number State | IL
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