Provider Demographics
NPI:1073837738
Name:KHAN, IMRAN A (BCBA)
Entity Type:Individual
Prefix:MR
First Name:IMRAN
Middle Name:A
Last Name:KHAN
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:857 N MARSHFIELD AVE
Mailing Address - Street 2:APT 3
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-5132
Mailing Address - Country:US
Mailing Address - Phone:312-513-5052
Mailing Address - Fax:
Practice Address - Street 1:857 N MARSHFIELD AVE
Practice Address - Street 2:APT 3
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-5132
Practice Address - Country:US
Practice Address - Phone:312-513-5052
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-23
Last Update Date:2010-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1-09-6640103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst