Provider Demographics
NPI:1598711202
Name:KHAWAJA, ABBAS A (MD)
Entity Type:Individual
Prefix:DR
First Name:ABBAS
Middle Name:A
Last Name:KHAWAJA
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 1:11 N EDGELAWN DR
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60506-4362
Mailing Address - Country:US
Mailing Address - Phone:630-264-3250
Mailing Address - Fax:630-264-1902
Practice Address - Street 1:11 N EDGELAWN DR
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60506-4362
Practice Address - Country:US
Practice Address - Phone:630-264-3250
Practice Address - Fax:630-264-1902
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-25
Last Update Date:2018-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036046187207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036046187Medicaid
IL060052720OtherMEDICARE RAILROAD
IL036046187Medicaid
ILK03781Medicare ID - Type Unspecified
IL060052720Medicare PIN
ILL52196Medicare ID - Type Unspecified
D11008Medicare UPIN