Provider Demographics
NPI:1962817494
Name:HAN, ANKITABEN (MD)
Entity Type:Individual
Prefix:
First Name:ANKITABEN
Middle Name:
Last Name:HAN
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 1:7000 W 111TH ST STE 210
Mailing Address - Street 2:
Mailing Address - City:WORTH
Mailing Address - State:IL
Mailing Address - Zip Code:60482-1851
Mailing Address - Country:US
Mailing Address - Phone:708-660-3200
Mailing Address - Fax:708-923-9818
Practice Address - Street 1:7000 W 111TH ST STE 210
Practice Address - Street 2:
Practice Address - City:WORTH
Practice Address - State:IL
Practice Address - Zip Code:60482-1851
Practice Address - Country:US
Practice Address - Phone:708-660-3200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125.065744207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine