Provider Demographics
NPI:1417110826
Name:KHAN, ASRA BATOOL (MD)
Entity Type:Individual
Prefix:
First Name:ASRA
Middle Name:BATOOL
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 1:901 S ASHLAND AVE
Mailing Address - Street 2:APT 202A
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-4001
Mailing Address - Country:US
Mailing Address - Phone:630-863-3042
Mailing Address - Fax:
Practice Address - Street 1:233 W JOE ORR RD
Practice Address - Street 2:
Practice Address - City:CHICAGO HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60411-1744
Practice Address - Country:US
Practice Address - Phone:708-709-7470
Practice Address - Fax:708-747-3497
Is Sole Proprietor?:No
Enumeration Date:2008-07-07
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036118937207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036-118937OtherIL LICENSE