Provider Demographics
NPI:1699751412
Name:KHAN, NIGHAT MONA (MD)
Entity type:Individual
Prefix:
First Name:NIGHAT
Middle Name:MONA
Last Name:KHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 W GRAND AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60654-5264
Mailing Address - Country:US
Mailing Address - Phone:312-329-1100
Mailing Address - Fax:312-329-1106
Practice Address - Street 1:330 W GRAND AVE
Practice Address - Street 2:SUITE A
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60654-5264
Practice Address - Country:US
Practice Address - Phone:312-329-1100
Practice Address - Fax:312-329-1106
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-22
Last Update Date:2008-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-105968207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01632801OtherBCBS PROVIDER NUMBER
IL036105968 1Medicaid
ILH62272OtherPROVIDER UPIN
IL01632801OtherBCBS PROVIDER NUMBER