Provider Demographics
NPI:1891281499
Name:KAMRAN KHAN, SC
Entity type:Organization
Organization Name:KAMRAN KHAN, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLER
Authorized Official - Prefix:
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:GUAGENTI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-480-5186
Mailing Address - Street 1:2720 S RIVER RD STE 218
Mailing Address - Street 2:
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60018-4111
Mailing Address - Country:US
Mailing Address - Phone:708-869-8120
Mailing Address - Fax:
Practice Address - Street 1:1890 SILVER CROSS BLVD STE 450
Practice Address - Street 2:
Practice Address - City:NEW LENOX
Practice Address - State:IL
Practice Address - Zip Code:60451-9518
Practice Address - Country:US
Practice Address - Phone:815-723-4387
Practice Address - Fax:815-723-4634
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-06
Last Update Date:2018-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036121940207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036121940Medicaid