Provider Demographics
NPI:1326229923
Name:KHAN, ASLAM M (MD, MM)
Entity Type:Individual
Prefix:DR
First Name:ASLAM
Middle Name:M
Last Name:KHAN
Suffix:
Gender:M
Credentials:MD, MM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:356 CHURCHILL ST
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60093-3221
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:356 CHURCHILL ST
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:IL
Practice Address - Zip Code:60093-3221
Practice Address - Country:US
Practice Address - Phone:224-558-1272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-25
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036082868207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GROUP # 1619414OtherBCBS GROUP# 1619414
IL036082868-1Medicaid
IL036082868-1Medicaid
PTAN 739531007-ICCMedicare PIN