Provider Demographics
NPI:1992778534
Name:KHAN, SABAH A (MD)
Entity type:Individual
Prefix:
First Name:SABAH
Middle Name:A
Last Name:KHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4646 N MARINE DR
Mailing Address - Street 2:SUITE 6200C
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-5759
Mailing Address - Country:US
Mailing Address - Phone:773-564-5313
Mailing Address - Fax:773-564-5314
Practice Address - Street 1:4646 N MARINE DR
Practice Address - Street 2:SUITE 6200C
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-5759
Practice Address - Country:US
Practice Address - Phone:773-564-5313
Practice Address - Fax:773-564-5314
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-13
Last Update Date:2014-03-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL036084303207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF45579Medicare UPIN