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NPI Code Detail

MEDICARE: DR. MOHAMMED KHAN M.D.

MEDICARE: DR. MOHAMMED KHAN M.D.
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
1390200000XStudent in an Organized Health Care Education/Training Program
2207R00000XInternal Medicine Physician036141637IL

General Provider Information

NPI Number : 1588075576
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MOHAMMED KHAN M.D.
Provider Business Mailing Address
First Line : 474 N LAKE SHORE DR APT 4510
Second Line :
City : CHICAGO
State : IL
Zip : 60611-6488
Country : US
Telephone Number : 312-342-4597
Fax Number :
Provider Business Practice Location Address
First Line : 12935 GREGORY ST
Second Line :
City : BLUE ISLAND
State : IL
Zip : 60406-2428
Country : US
Telephone Number : 708-597-2000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/13/2014
Last Update Date : 03/17/2018

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