Provider Demographics
NPI:1518917673
Name:KHAN, GOWHAR A (MD)
Entity Type:Individual
Prefix:
First Name:GOWHAR
Middle Name:A
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 1:2309 BILTER RD
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60502-8714
Mailing Address - Country:US
Mailing Address - Phone:630-802-8644
Mailing Address - Fax:630-801-7511
Practice Address - Street 1:1177 N HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60506-2281
Practice Address - Country:US
Practice Address - Phone:630-802-8644
Practice Address - Fax:630-801-7511
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-11
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036087821207R00000X, 207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK23698Medicare UPIN
IL529160Medicare ID - Type Unspecified
IL212792Medicare UPIN
ILF80428Medicare UPIN