Provider Demographics
NPI:1831100569
Name:KHAN, SALEHA (MD)
Entity Type:Individual
Prefix:
First Name:SALEHA
Middle Name:
Last Name:KHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9465 FALLING WATERS DR W
Mailing Address - Street 2:
Mailing Address - City:BURR RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60527-6897
Mailing Address - Country:US
Mailing Address - Phone:630-914-5373
Mailing Address - Fax:630-410-8528
Practice Address - Street 1:9465 EST FALLINGWATER DRIVE
Practice Address - Street 2:
Practice Address - City:BURR RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60521
Practice Address - Country:US
Practice Address - Phone:630-914-5373
Practice Address - Fax:630-410-8528
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2014-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036084178207Q00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036-084178OtherSTATE LICENSE