Provider Demographics
NPI:1801937545
Name:KHAN, MOHAMMAD RAZA (MD)
Entity type:Individual
Prefix:MR
First Name:MOHAMMAD
Middle Name:RAZA
Last Name:KHAN
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 REVERE DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010-9584
Mailing Address - Country:US
Mailing Address - Phone:138-850-0525
Mailing Address - Fax:
Practice Address - Street 1:30 REVERE DR
Practice Address - Street 2:
Practice Address - City:SOUTH BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-9584
Practice Address - Country:US
Practice Address - Phone:513-885-0052
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2025-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036118940207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL05623778OtherBLUE CROSS BLUE SHIELD
IL05623778OtherBLUE CROSS BLUE SHIELD
OH0875009Medicare ID - Type Unspecified
IL05623778OtherBLUE CROSS BLUE SHIELD
G53725Medicare UPIN
P00477198Medicare PIN