Provider Demographics
NPI:1710547625
Name:KHAN, NADIA (SFA)
Entity Type:Individual
Prefix:
First Name:NADIA
Middle Name:
Last Name:KHAN
Suffix:
Gender:F
Credentials:SFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4543 N MALDEN ST APT 1S
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-5687
Mailing Address - Country:US
Mailing Address - Phone:773-603-4125
Mailing Address - Fax:
Practice Address - Street 1:4543 N MALDEN ST APT 1S
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-5687
Practice Address - Country:US
Practice Address - Phone:773-603-4125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-13
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL238.0006.36363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical