Provider Demographics
NPI:1619947264
Name:KHAN, SAEED AHMAD (MD)
Entity Type:Individual
Prefix:DR
First Name:SAEED
Middle Name:AHMAD
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 1:205 BAILEY LANE
Mailing Address - Street 2:BENTON MEDICAL CENTER SAEED A KHAN MD
Mailing Address - City:BENTON
Mailing Address - State:IL
Mailing Address - Zip Code:62812-1921
Mailing Address - Country:US
Mailing Address - Phone:618-435-8189
Mailing Address - Fax:618-439-3173
Practice Address - Street 1:205 BAILEY LANE
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:IL
Practice Address - Zip Code:62812-1921
Practice Address - Country:US
Practice Address - Phone:618-435-8189
Practice Address - Fax:618-439-3173
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-25
Last Update Date:2009-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36052011207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036052011Medicaid
IL0002800061OtherBLUE CROSS BLUE SHIELD
025754OtherHEALTH ALLIANCE
ILL012825OtherTRICARE
135523OtherHEALTHLINK
IL036052011Medicaid
210336Medicare ID - Type Unspecified