Provider Demographics
NPI:1417931874
Name:KHAN, ARIF ALI (MD)
Entity Type:Individual
Prefix:
First Name:ARIF
Middle Name:ALI
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 1:777 PARK AVE. WEST
Mailing Address - Street 2:IM HOSPITALISTS
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035-2433
Mailing Address - Country:US
Mailing Address - Phone:847-926-5840
Mailing Address - Fax:847-926-5835
Practice Address - Street 1:777 PARK AVE. WEST
Practice Address - Street 2:IM HOSPITALISTS
Practice Address - City:HIGHLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60035
Practice Address - Country:US
Practice Address - Phone:847-926-5840
Practice Address - Fax:847-926-5835
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2019-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036116162207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5808693Medicaid
VA010317568Medicaid
VA010317568Medicaid
001136C40Medicare PIN
VA010711C19Medicare PIN