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NPI Code Detail

MEDICARE: FAHMIDA KHATOON PA

MEDICARE: FAHMIDA KHATOON PA
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
1363A00000XPhysician Assistant085003418IL

General Provider Information

NPI Number : 1891938619
Entity Type Code : Individual
Provider Name (Legal Business Name) : FAHMIDA KHATOON PA
Provider Business Mailing Address
First Line : 9921 SOUTHWEST HWY
Second Line :
City : OAK LAWN
State : IL
Zip : 60453-3754
Country : US
Telephone Number : 708-488-5678
Fax Number :
Provider Business Practice Location Address
First Line : 2734 W 87TH ST
Second Line :
City : CHICAGO
State : IL
Zip : 60652-3937
Country : US
Telephone Number : 773-918-4700
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/09/2009
Last Update Date : 10/07/2017

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Directions to “ FAHMIDA KHATOON PA” Practice Location

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