Provider Demographics
NPI:1386678183
Name:KHAN, MUHAMMED S (MD)
Entity Type:Individual
Prefix:
First Name:MUHAMMED
Middle Name:S
Last Name:KHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:201 S WABENA AVE
Mailing Address - Street 2:LL B
Mailing Address - City:MINOOKA
Mailing Address - State:IL
Mailing Address - Zip Code:60447-8715
Mailing Address - Country:US
Mailing Address - Phone:815-941-9124
Mailing Address - Fax:815-941-9128
Practice Address - Street 1:201 S WABENA AVE
Practice Address - Street 2:
Practice Address - City:MINOOKA
Practice Address - State:IL
Practice Address - Zip Code:60447-8715
Practice Address - Country:US
Practice Address - Phone:815-467-1518
Practice Address - Fax:815-467-7419
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G35388Medicare UPIN