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1548255243

NPI Code Detail

MEDICARE: DR. NAFEES KHAN MD

MEDICARE: DR. NAFEES 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	2080A0000X	Pediatric Adolescent Medicine Physician	036096917	IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00469958	OTHER	IL	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	99106	OTHER		WELLMARK

General Provider Information

NPI Number	:	1548255243
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NAFEES KHAN MD

Provider Business Mailing Address
First Line	:	611 W. PARK ST.
Second Line	:	FAPC
City	:	URBANA
State	:	IL
Zip	:	61801
Country	:	US
Telephone Number	:	217-902-5291
Fax Number	:

Provider Business Practice Location Address
First Line	:	2512 HURST DR STE 130
Second Line	:
City	:	MATTOON
State	:	IL
Zip	:	61938-9200
Country	:	US
Telephone Number	:	217-258-5900
Fax Number	:

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

Provider Enumeration Date	:	09/19/2005
Last Update Date	:	12/12/2019

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Directions to “ DR. NAFEES KHAN MD” Practice Location

Language	Start Address	Practice Location

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