Provider Demographics
NPI:1154413136
Name:KHAN, NADIA (MD)
Entity type:Individual
Prefix:
First Name:NADIA
Middle Name:
Last Name:KHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NADIA
Other - Middle Name:
Other - Last Name:ALAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7 BLANCHARD CIR
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60189-2037
Mailing Address - Country:US
Mailing Address - Phone:630-653-0848
Mailing Address - Fax:630-653-0988
Practice Address - Street 1:7 BLANCHARD CIR
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60189-2037
Practice Address - Country:US
Practice Address - Phone:630-653-0848
Practice Address - Fax:630-653-0988
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2013-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036114987207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036114987Medicaid
IL920540OtherMEDICARE PTAN (GROUP)
ILP01138107OtherRAILROAD MEDICARE (PROVIDER PTAN)
IL920540018OtherMEDICARE PTAN (INDIVIDUAL)
IL365820Medicare PIN