Provider Demographics
NPI:1275687071
Name:KHAN, ABDUL HAYE (MD)
Entity Type:Individual
Prefix:DR
First Name:ABDUL
Middle Name:HAYE
Last Name:KHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
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:SUITE 102
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
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0021608752OtherBLUE CROSS BLUE SHIELD
IL0021608752OtherBLUE CROSS BLUE SHIELD