Provider Demographics
NPI:1659396497
Name:KHAN, FAISAL Q (MD)
Entity Type:Individual
Prefix:
First Name:FAISAL
Middle Name:Q
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 1:302 RANDALL RD
Mailing Address - Street 2:CADENCE PHYSICIAN GROUP
Mailing Address - City:GENEVA
Mailing Address - State:IL
Mailing Address - Zip Code:60134-4220
Mailing Address - Country:US
Mailing Address - Phone:630-262-7400
Mailing Address - Fax:630-262-3760
Practice Address - Street 1:302 RANDALL RD.
Practice Address - Street 2:CADENCE PHYSICIAN GROUP
Practice Address - City:GENEVA
Practice Address - State:IL
Practice Address - Zip Code:60134-4220
Practice Address - Country:US
Practice Address - Phone:630-262-7400
Practice Address - Fax:630-262-3760
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2014-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036135009207RG0100X
MI4301081794207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI488406710Medicaid
ILF400137084OtherMEDICARE (INDIVIDUAL)
FK081794OtherCOMMERCIAL-COMMERCIAL NUMBER
FK081794OtherCHAMPUS-CHAMPUS
IL206147OtherMEDICARE (GROUP)
700H262220OtherBLUE CROSS-BLUE CROSS
FK081794OtherCOMMERCIAL-COMMERCIAL NUMBER
0H26222519Medicare ID - Type Unspecified