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NPI Code Detail

MEDICARE: MARIA KHATTAK M.D.

MEDICARE: MARIA KHATTAK 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
1207Q00000XFamily Medicine Physician036136594IL

General Provider Information

NPI Number : 1740545441
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARIA KHATTAK M.D.
Provider Business Mailing Address
First Line : 1836 S MACARTHUR BLVD
Second Line :
City : SPRINGFIELD
State : IL
Zip : 62704-4030
Country : US
Telephone Number : 217-789-1403
Fax Number : 217-789-1825
Provider Business Practice Location Address
First Line : 1836 S MACARTHUR BLVD
Second Line :
City : SPRINGFIELD
State : IL
Zip : 62704-4030
Country : US
Telephone Number : 217-789-1403
Fax Number : 217-789-1825
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/09/2012
Last Update Date : 12/04/2015

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Directions to “ MARIA KHATTAK M.D.” Practice Location

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