MEDICARE: MR. MEHDI 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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1366241804
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MEHDI KHAN

Provider Business Mailing Address
First Line	:	6432 N HERMITAGE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60626-5770
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6432 N HERMITAGE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60626-5770
Country	:	US
Telephone Number	:	312-973-0719
Fax Number	:

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

Provider Enumeration Date	:	03/08/2025
Last Update Date	:	03/08/2025

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Directions to “ MR. MEHDI KHAN ” Practice Location

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