Provider Demographics
NPI:1386865244
Name:KHOKHAR, OMAR S (MD)
Entity Type:Individual
Prefix:DR
First Name:OMAR
Middle Name:S
Last Name:KHOKHAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:OMAR
Other - Middle Name:S
Other - Last Name:KHOKHAR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1701 E COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61704-2101
Mailing Address - Country:US
Mailing Address - Phone:309-664-3000
Mailing Address - Fax:309-664-3026
Practice Address - Street 1:1701 E COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61704-2101
Practice Address - Country:US
Practice Address - Phone:309-664-3000
Practice Address - Fax:309-664-3026
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2014-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36117349207R00000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine