Provider Demographics
NPI:1104082320
Name:KHAN, FAROOQ ANWAR (MD)
Entity type:Individual
Prefix:
First Name:FAROOQ
Middle Name:ANWAR
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 1:907 N ELM ST STE 101
Mailing Address - Street 2:
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-3644
Mailing Address - Country:US
Mailing Address - Phone:708-482-4500
Mailing Address - Fax:708-482-4502
Practice Address - Street 1:907 N ELM ST STE 101
Practice Address - Street 2:
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-3644
Practice Address - Country:US
Practice Address - Phone:708-482-4500
Practice Address - Fax:708-482-4502
Is Sole Proprietor?:No
Enumeration Date:2008-08-07
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125048096207L00000X
IL036125625207LP2900X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
1164451308OtherGROUP NPI