Provider Demographics
NPI:1770531360
Name:KHAN, LUBNA (MD)
Entity type:Individual
Prefix:
First Name:LUBNA
Middle Name:
Last Name:KHAN
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 1:1463 LANTERN CIR
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-8333
Mailing Address - Country:US
Mailing Address - Phone:248-346-7125
Mailing Address - Fax:
Practice Address - Street 1:301 MADISON ST
Practice Address - Street 2:SUITE 306
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-6549
Practice Address - Country:US
Practice Address - Phone:815-725-6331
Practice Address - Fax:815-725-4709
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2009-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.119733207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI104573183Medicaid
MIP00069869Medicare ID - Type UnspecifiedRAILROAD
MI0M71810039Medicare ID - Type Unspecified
MI104573183Medicaid