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NPI Code Detail

MEDICARE: ASMA SYED KHAN D.O.

MEDICARE: ASMA SYED KHAN D.O.
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
1208000000XPediatrics Physician288804-1NY
2208000000XPediatrics Physician036146664IL

General Provider Information

NPI Number : 1568877678
Entity Type Code : Individual
Provider Name (Legal Business Name) : ASMA SYED KHAN D.O.
Provider Business Mailing Address
First Line : 1502 PARKVIEW AVE
Second Line :
City : ROCKFORD
State : IL
Zip : 61107-1821
Country : US
Telephone Number : 815-381-7250
Fax Number : 815-381-7251
Provider Business Practice Location Address
First Line : 1502 PARKVIEW AVE
Second Line :
City : ROCKFORD
State : IL
Zip : 61107-1821
Country : US
Telephone Number : 815-381-7250
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/26/2014
Last Update Date : 09/21/2018

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