Provider Demographics
NPI:1346289188
Name:ISHKHAN, KHACHIG K (MD)
Entity Type:Individual
Prefix:DR
First Name:KHACHIG
Middle Name:K
Last Name:ISHKHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:KHACHIG
Other - Middle Name:K
Other - Last Name:ICHKHAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:5600 W ADDISON
Mailing Address - Street 2:SUITE 400
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60634
Mailing Address - Country:US
Mailing Address - Phone:773-283-2448
Mailing Address - Fax:773-283-0205
Practice Address - Street 1:5600 W ADDISON
Practice Address - Street 2:SUITE 400
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60634
Practice Address - Country:US
Practice Address - Phone:773-283-2448
Practice Address - Fax:773-283-0205
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2013-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0366087395207RC0000X
IL036087395207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036087395Medicaid
IL036087395Medicaid
IL036087395Medicaid