Provider Demographics
NPI:1164636585
Name:N M KHAN M D S C
Entity Type:Organization
Organization Name:N M KHAN M D S C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NOORUN
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-244-2841
Mailing Address - Street 1:PO BOX 393
Mailing Address - Street 2:
Mailing Address - City:WORTH
Mailing Address - State:IL
Mailing Address - Zip Code:60482-0393
Mailing Address - Country:US
Mailing Address - Phone:630-551-1097
Mailing Address - Fax:630-551-1097
Practice Address - Street 1:7600 W COLLEGE DR
Practice Address - Street 2:2ND FLOOR
Practice Address - City:PALOS HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60463-1001
Practice Address - Country:US
Practice Address - Phone:708-671-1800
Practice Address - Fax:708-671-1803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2012-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========OtherEIN
IL559760Medicare ID - Type Unspecified