Provider Demographics
NPI:1023018322
Name:KHAN, ASRA F (MD)
Entity Type:Individual
Prefix:
First Name:ASRA
Middle Name:F
Last Name:KHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1850 GATEWAY DR
Mailing Address - Street 2:
Mailing Address - City:SYCAMORE
Mailing Address - State:IL
Mailing Address - Zip Code:60178-3192
Mailing Address - Country:US
Mailing Address - Phone:815-217-3252
Mailing Address - Fax:815-639-8451
Practice Address - Street 1:1850 GATEWAY DR
Practice Address - Street 2:
Practice Address - City:SYCAMORE
Practice Address - State:IL
Practice Address - Zip Code:60178-3192
Practice Address - Country:US
Practice Address - Phone:815-217-3252
Practice Address - Fax:815-639-8451
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2017-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-108050207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL834340OtherMEDICARE GROUP #
ILIL6310OtherMEDICARE GROUP
ILF400282877OtherMEDICARE INDIVIDUAL
IL036108050OtherMEDICAID
ILP00731185OtherRAILROAD MEDICARE
IL553180OtherMEDICARE GROUP #
IL553180012Medicare PIN
ILF400282877OtherMEDICARE INDIVIDUAL
IL553180OtherMEDICARE GROUP #
IL834340OtherMEDICARE GROUP #