Provider Demographics
NPI:1396810370
Name:KHAN, MOHAMMAD H (MD)
Entity type:Individual
Prefix:DR
First Name:MOHAMMAD
Middle Name:H
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 1:474 NORTH LAKE SHORE DRIVE
Mailing Address - Street 2:APT 4510
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-6488
Mailing Address - Country:US
Mailing Address - Phone:312-224-8764
Mailing Address - Fax:
Practice Address - Street 1:474 NORTH LAKE SHORE DRIVE
Practice Address - Street 2:APT 4510
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-6488
Practice Address - Country:US
Practice Address - Phone:312-224-8764
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036090466207RG0100X
IN01063260A207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1396810370Medicaid
IL036090466Medicaid
IN200458220Medicaid
IL036090466Medicaid