Provider Demographics
NPI:1427467703
Name:KHAN, SAMEER (DPM)
Entity type:Individual
Prefix:DR
First Name:SAMEER
Middle Name:
Last Name:KHAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:684 CITADEL DR
Mailing Address - Street 2:
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-5559
Mailing Address - Country:US
Mailing Address - Phone:708-271-7756
Mailing Address - Fax:
Practice Address - Street 1:1S450 SUMMIT AVE STE 180A
Practice Address - Street 2:
Practice Address - City:OAKBROOK TERRACE
Practice Address - State:IL
Practice Address - Zip Code:60181-3990
Practice Address - Country:US
Practice Address - Phone:630-468-0442
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-12
Last Update Date:2018-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN966213ES0103X
NYR93661213ES0103X
IL016005804213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery