Provider Demographics
NPI:1134371057
Name:KHAN, AISHA (DPM)
Entity type:Individual
Prefix:
First Name:AISHA
Middle Name:
Last Name:KHAN
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6940 N KEATING AVE
Mailing Address - Street 2:
Mailing Address - City:LINCOLNWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60712-2408
Mailing Address - Country:US
Mailing Address - Phone:713-992-6113
Mailing Address - Fax:224-251-8861
Practice Address - Street 1:6353 N FAIRFIELD AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60659-1705
Practice Address - Country:US
Practice Address - Phone:773-954-6414
Practice Address - Fax:224-251-8861
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-22
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016005150213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery