Provider Demographics
NPI:1174636013
Name:KHAN, MOHSIN (MD)
Entity Type:Individual
Prefix:DR
First Name:MOHSIN
Middle Name:
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 1:2350 N ROCKTON AVE
Mailing Address - Street 2:ROCKFORD HEALTH PHYSICIANS
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61103-3600
Mailing Address - Country:US
Mailing Address - Phone:815-971-7600
Mailing Address - Fax:815-971-9901
Practice Address - Street 1:2350 N ROCKTON AVE
Practice Address - Street 2:ROCKFORD HEALTH PHYSICIANS
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61103-3600
Practice Address - Country:US
Practice Address - Phone:815-971-7600
Practice Address - Fax:815-971-9901
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2014-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL361159592084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL616040102OtherPTAN
IL36115959Medicaid