Provider Demographics
NPI:1538346200
Name:KHAN, IRTAZA IQBAL (MB,BS)
Entity type:Individual
Prefix:DR
First Name:IRTAZA
Middle Name:IQBAL
Last Name:KHAN
Suffix:
Gender:M
Credentials:MB,BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2626 N LAKEVIEW AVE APT 1003
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-1811
Mailing Address - Country:US
Mailing Address - Phone:336-830-4261
Mailing Address - Fax:
Practice Address - Street 1:2626 N LAKEVIEW AVE APT 1003
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-1811
Practice Address - Country:US
Practice Address - Phone:336-830-4261
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-24
Last Update Date:2022-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036139669207RC0200X
NC2013-02324207RC0200X, 207RP1001X
IN01079695A207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease