Provider Demographics
NPI:1902025406
Name:RAHAMAN, KHALILUR (DN)
Entity Type:Individual
Prefix:
First Name:KHALILUR
Middle Name:
Last Name:RAHAMAN
Suffix:
Gender:M
Credentials:DN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:281 E WRIGHTWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60139-2626
Mailing Address - Country:US
Mailing Address - Phone:630-863-5707
Mailing Address - Fax:
Practice Address - Street 1:281 E WRIGHTWOOD AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60139-2626
Practice Address - Country:US
Practice Address - Phone:630-863-5707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL172P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172P00000XOther Service ProvidersNaprapath