Provider Demographics
NPI:1053509448
Name:AHK SURGICAL S.C.
Entity Type:Organization
Organization Name:AHK SURGICAL S.C.
Other - Org Name:ABDUL HAYE KHAN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWENER
Authorized Official - Prefix:
Authorized Official - First Name:ADBUL
Authorized Official - Middle Name:HAYE
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-636-4116
Mailing Address - Street 1:PO BOX 248
Mailing Address - Street 2:
Mailing Address - City:WORTH
Mailing Address - State:IL
Mailing Address - Zip Code:60482-0248
Mailing Address - Country:US
Mailing Address - Phone:708-532-5660
Mailing Address - Fax:708-532-5661
Practice Address - Street 1:2850 W 95TH ST
Practice Address - Street 2:
Practice Address - City:EVERGREEN PARK
Practice Address - State:IL
Practice Address - Zip Code:60805-2735
Practice Address - Country:US
Practice Address - Phone:708-636-4116
Practice Address - Fax:708-636-5346
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-10
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0021608752OtherBLUE CROSS BLUE SHIELD
IL459081Medicare PIN