Provider Demographics
NPI:1811174105
Name:KHAN, HUMAIRA (MD)
Entity type:Individual
Prefix:
First Name:HUMAIRA
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:P.O. BOX 2753
Mailing Address - Street 2:
Mailing Address - City:BEDFORD PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60499-2753
Mailing Address - Country:US
Mailing Address - Phone:708-597-2000
Mailing Address - Fax:708-824-4505
Practice Address - Street 1:2310 YORK STREET
Practice Address - Street 2:2A PAVILION
Practice Address - City:BLUE ISLAND
Practice Address - State:IL
Practice Address - Zip Code:60406-2428
Practice Address - Country:US
Practice Address - Phone:708-597-2000
Practice Address - Fax:708-824-4505
Is Sole Proprietor?:No
Enumeration Date:2008-01-29
Last Update Date:2009-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036118421207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine