Provider Demographics
NPI:1942297577
Name:KHAN, AMJAD (MD)
Entity Type:Individual
Prefix:
First Name:AMJAD
Middle Name:
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 1:777 OAKMONT LN
Mailing Address - Street 2:SUITE 1600
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-5511
Mailing Address - Country:US
Mailing Address - Phone:630-789-2550
Mailing Address - Fax:
Practice Address - Street 1:1 S 161 SUMMIT
Practice Address - Street 2:
Practice Address - City:OAK BROOK TERRACE
Practice Address - State:IL
Practice Address - Zip Code:60181-3904
Practice Address - Country:US
Practice Address - Phone:630-932-8000
Practice Address - Fax:630-932-8025
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-29
Last Update Date:2012-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036047270207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL21606805OtherBCBS PROVIDER ID
IL036047270Medicaid
IL110231353OtherRAILROAD MEDICARE
ILC44975Medicare UPIN
ILL29927Medicare PIN
IL110231353OtherRAILROAD MEDICARE
ILL81481Medicare PIN