MEDICARE: ASRA F KHAN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	036-108050	IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	834340	OTHER	IL	MEDICARE GROUP #
2	IL6310	OTHER	IL	MEDICARE GROUP
3	F400282877	OTHER	IL	MEDICARE INDIVIDUAL
5	P00731185	OTHER	IL	RAILROAD MEDICARE
6	553180	OTHER	IL	MEDICARE GROUP #

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023018322
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASRA F KHAN MD

Provider Business Mailing Address
First Line	:	1850 GATEWAY DR
Second Line	:
City	:	SYCAMORE
State	:	IL
Zip	:	60178-3192
Country	:	US
Telephone Number	:	815-217-3252
Fax Number	:	815-639-8451

Provider Business Practice Location Address
First Line	:	1850 GATEWAY DR
Second Line	:
City	:	SYCAMORE
State	:	IL
Zip	:	60178-3192
Country	:	US
Telephone Number	:	815-217-3252
Fax Number	:	815-639-8451

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/28/2005
Last Update Date	:	05/12/2017

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Directions to “ ASRA F KHAN MD” Practice Location

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