MEDICARE: ANJUM F KHAN NP

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	363LF0000X	Family Nurse Practitioner	277001490	IL
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	277001490	IL
3	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	14955-33	WI
4	363LF0000X	Family Nurse Practitioner	14955	WI

Other Identifiers

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

General Provider Information

NPI Number	:	1548651979
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANJUM F KHAN NP

Provider Business Mailing Address
First Line	:	29373 NETWORK PL
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60673-1293
Country	:	US
Telephone Number	:	847-390-5900
Fax Number	:

Provider Business Practice Location Address
First Line	:	4753 N BROADWAY ST STE 403
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-7910
Country	:	US
Telephone Number	:	773-989-2780
Fax Number	:

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

Provider Enumeration Date	:	02/06/2015
Last Update Date	:	12/08/2025

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