Provider Demographics
NPI:1043484736
Name:KHAN, AJAZ M (MD)
Entity Type:Individual
Prefix:DR
First Name:AJAZ
Middle Name:M
Last Name:KHAN
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:CANCER TREATMENT CENTERS OF AMERICA
Mailing Address - Street 2:2361 PAYSPHERE CIRCLE
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60674
Mailing Address - Country:US
Mailing Address - Phone:800-322-9183
Mailing Address - Fax:
Practice Address - Street 1:CANCER TREATMENT CENTERS OF AMERICA
Practice Address - Street 2:2520 ELISHA AVENUE
Practice Address - City:ZION
Practice Address - State:IL
Practice Address - Zip Code:60099
Practice Address - Country:US
Practice Address - Phone:800-322-9183
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-15
Last Update Date:2022-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY238121207RH0003X
IL036-122000207RH0003X
NJMA082147207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL833160001Medicare PIN