Provider Demographics
NPI:1538281399
Name:ILIAS-KHAN, NASREEN AJMAL (MD)
Entity Type:Individual
Prefix:DR
First Name:NASREEN
Middle Name:AJMAL
Last Name:ILIAS-KHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NASREEN
Other - Middle Name:A
Other - Last Name:ILIAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:700 NE 87TH AVE
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98664-1913
Mailing Address - Country:US
Mailing Address - Phone:360-882-2778
Mailing Address - Fax:360-604-1767
Practice Address - Street 1:700 NE 87TH AVE
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98664
Practice Address - Country:US
Practice Address - Phone:360-882-2778
Practice Address - Fax:360-604-1767
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2018-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60479570207RC0000X
ORMD155921207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2038720Medicaid
OR500638606Medicaid