MEDICARE: DR. MALIK MUHAMMAD ZEESHANSHER KHAN DDS

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	122300000X	Dentist	019.032379	IL

General Provider Information

NPI Number	:	1063060275
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MALIK MUHAMMAD ZEESHANSHER KHAN DDS

Provider Business Mailing Address
First Line	:	233 E WACKER DR APT 3902
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60601-5115
Country	:	US
Telephone Number	:	616-634-8934
Fax Number	:

Provider Business Practice Location Address
First Line	:	2702 W TOUHY AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60645-3008
Country	:	US
Telephone Number	:	773-338-7799
Fax Number	:

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

Provider Enumeration Date	:	08/30/2019
Last Update Date	:	08/30/2019

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