Provider Demographics
NPI:1598767493
Name:KHAN, MUHAMMAD N (MD)
Entity Type:Individual
Prefix:
First Name:MUHAMMAD
Middle Name:N
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 1:2975 N WATER ST
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62526-4235
Mailing Address - Country:US
Mailing Address - Phone:217-875-3810
Mailing Address - Fax:217-875-5015
Practice Address - Street 1:2975 N WATER ST
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62526-4235
Practice Address - Country:US
Practice Address - Phone:217-875-3810
Practice Address - Fax:217-875-5015
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-11
Last Update Date:2015-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036094564207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL060932OtherHEALTH ALLIANCE
IL110205043OtherRAILROAD MEDICARE
IL339926OtherHEALTHLINK
7200149OtherAETNA
05826169OtherBLUE CROSS
IL036094564Medicaid
IL036094564Medicaid
IL110205043OtherRAILROAD MEDICARE
IL110205043OtherRAILROAD MEDICARE