Provider Demographics
NPI:1568455327
Name:KHAN, RAZA M (MD)
Entity Type:Individual
Prefix:DR
First Name:RAZA
Middle Name:M
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 1:3 S GREENLEAF ST
Mailing Address - Street 2:SUITE J
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-3377
Mailing Address - Country:US
Mailing Address - Phone:847-599-1111
Mailing Address - Fax:847-599-1148
Practice Address - Street 1:3 S GREENLEAF ST
Practice Address - Street 2:SUITE J
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-3377
Practice Address - Country:US
Practice Address - Phone:847-599-1111
Practice Address - Fax:847-599-1148
Is Sole Proprietor?:No
Enumeration Date:2005-08-26
Last Update Date:2019-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036045549208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036045549Medicaid
1635877OtherBCBS
ILC43268Medicare UPIN
K53020Medicare PIN
IL036045549Medicaid