Provider Demographics
NPI:1316946288
Name:KHAN, ALAM A (MD)
Entity type:Individual
Prefix:DR
First Name:ALAM
Middle Name:A
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 1:2800 N SHERIDAN RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-6157
Mailing Address - Country:US
Mailing Address - Phone:773-472-5803
Mailing Address - Fax:
Practice Address - Street 1:2800 N. SHERIDAN RD
Practice Address - Street 2:SUITE 400
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-6157
Practice Address - Country:US
Practice Address - Phone:773-472-5803
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036085778207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036085778Medicaid
110091993OtherMEDICARE RAILROAD
ILF69781Medicare UPIN
IL036085778Medicaid