Provider Demographics
NPI:1831283480
Name:KHAN, HAMIDA (MD)
Entity Type:Individual
Prefix:DR
First Name:HAMIDA
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 1:225 E CHICAGO AVE
Mailing Address - Street 2:BOX 152
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2991
Mailing Address - Country:US
Mailing Address - Phone:773-880-6903
Mailing Address - Fax:773-880-3068
Practice Address - Street 1:225 E CHICAGO AVE
Practice Address - Street 2:BOX 152
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2991
Practice Address - Country:US
Practice Address - Phone:773-880-6903
Practice Address - Fax:773-880-3068
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360677142080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036067714Medicaid
IL370017432Medicare ID - Type Unspecified
IL036067714Medicaid