Provider Demographics
NPI:1407807746
Name:KHAN, SYED J (MD)
Entity Type:Individual
Prefix:
First Name:SYED
Middle Name:J
Last Name:KHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3249 OAK PARK AVE
Mailing Address - Street 2:
Mailing Address - City:BERWYN
Mailing Address - State:IL
Mailing Address - Zip Code:60402-3429
Mailing Address - Country:US
Mailing Address - Phone:708-783-3601
Mailing Address - Fax:
Practice Address - Street 1:3249 OAK PARK AVE
Practice Address - Street 2:
Practice Address - City:BERWYN
Practice Address - State:IL
Practice Address - Zip Code:60402-3429
Practice Address - Country:US
Practice Address - Phone:708-783-3601
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01061501A2084P0804X
IL0361208542084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN388979OtherMANAGED HEALTH NETWORK
IN577438OtherVALUE OPTIONS
IND03211OtherMEDICARE RR GRP#
INP01191767OtherRR MEDICARE PTAN
IN000000775649OtherANTHEM
IN209931580AMedicaid
IN000000691246OtherANTHEM
IN200825610Medicaid
IN2298696OtherCIGNA BEHAVIORAL HEALTH
IN7029777OtherAETNA
IN577438OtherVALUE OPTIONS
IN7029777OtherAETNA
IN000000691246OtherANTHEM
IN200825610Medicaid