Provider Demographics
NPI:1003014457
Name:KHAJA, ASLAM MOHAMMED (MD)
Entity Type:Individual
Prefix:MR
First Name:ASLAM
Middle Name:MOHAMMED
Last Name:KHAJA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22285 N PEPPER RD
Mailing Address - Street 2:SUITE 401
Mailing Address - City:LAKE BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010-2538
Mailing Address - Country:US
Mailing Address - Phone:847-882-6604
Mailing Address - Fax:847-882-6228
Practice Address - Street 1:22285 N PEPPER RD
Practice Address - Street 2:SUITE 401
Practice Address - City:LAKE BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-2538
Practice Address - Country:US
Practice Address - Phone:847-882-6604
Practice Address - Fax:847-882-6228
Is Sole Proprietor?:No
Enumeration Date:2007-07-06
Last Update Date:2017-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.1188442084N0400X
IL0361188442084V0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084V0102XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyVascular Neurology
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036118844Medicaid
IL20614135OtherMEDICARE PTAN (INDIVIDUAL)
IL206147OtherMEDICARE PTAN (GROUP)
ILP01144160OtherRAILROAD MEDICARE INDIVIDUAL PTAN