Provider Demographics
NPI:1295471530
Name:KHAN, TALHA MOHAMMAD (MD)
Entity type:Individual
Prefix:DR
First Name:TALHA
Middle Name:MOHAMMAD
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 1:11100 EUCLID AVE
Mailing Address - Street 2:LAKESIDE BUILDING SUITE 6223
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44106
Mailing Address - Country:US
Mailing Address - Phone:216-844-3944
Mailing Address - Fax:216-844-1949
Practice Address - Street 1:2200 FORT JESSE RD STE 110
Practice Address - Street 2:
Practice Address - City:NORMAL
Practice Address - State:IL
Practice Address - Zip Code:61761-6286
Practice Address - Country:US
Practice Address - Phone:309-661-6290
Practice Address - Fax:309-451-1354
Is Sole Proprietor?:No
Enumeration Date:2022-05-10
Last Update Date:2025-08-27
Deactivation Date:2022-12-21
Deactivation Code:
Reactivation Date:2022-12-28
Provider Licenses
StateLicense IDTaxonomies
390200000X
IL036176653207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program