Provider Demographics
NPI:1437445202
Name:KHAN, TAARIQ AHSAN (MD)
Entity Type:Individual
Prefix:
First Name:TAARIQ
Middle Name:AHSAN
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 1:2338 W VAN WINKLE WAY
Mailing Address - Street 2:SUITE 3300
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61615-7483
Mailing Address - Country:US
Mailing Address - Phone:309-693-2020
Mailing Address - Fax:
Practice Address - Street 1:2338 W VAN WINKLE WAY
Practice Address - Street 2:SUITE 3300
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61615-7483
Practice Address - Country:US
Practice Address - Phone:309-693-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-21
Last Update Date:2015-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036133745207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine