Provider Demographics
NPI:1376578294
Name:KHAN, SEEMIN GUL (MD)
Entity Type:Individual
Prefix:
First Name:SEEMIN
Middle Name:GUL
Last Name:KHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 MEADOWVIEW DRIVE
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60093
Mailing Address - Country:US
Mailing Address - Phone:773-275-5030
Mailing Address - Fax:
Practice Address - Street 1:5140 NORTH CALIFORNIA AVENUE
Practice Address - Street 2:SUITE 755
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625
Practice Address - Country:US
Practice Address - Phone:773-275-5030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036051676207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL31600490OtherBLUE SHIELD
IL036051676Medicaid
IL710140Medicare PIN
0780810001Medicare NSC
IL31600490OtherBLUE SHIELD
IL180002018Medicare PIN