MEDICARE: DR. MOHAMMAD RAFI KHAN

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		IL

General Provider Information

NPI Number	:	1083831895
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MOHAMMAD RAFI KHAN

Provider Business Mailing Address
First Line	:	105 E 20TH ST
Second Line	:
City	:	LOMBARD
State	:	IL
Zip	:	60148-4967
Country	:	US
Telephone Number	:	630-853-3478
Fax Number	:	773-947-8664

Provider Business Practice Location Address
First Line	:	1952 EAST 73 STREE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60649
Country	:	US
Telephone Number	:	773-947-8664
Fax Number	:	773-947-8664

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

Provider Enumeration Date	:	04/20/2007
Last Update Date	:	07/08/2007

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