Provider Demographics
NPI:1144647082
Name:KHAN, ABDUL BILAL (MD)
Entity type:Individual
Prefix:DR
First Name:ABDUL BILAL
Middle Name:
Last Name:KHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ABDUL BILAL
Other - Middle Name:
Other - Last Name:KHAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:555 10TH ST UNIT 102
Mailing Address - Street 2:
Mailing Address - City:PALISADES PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07650-3152
Mailing Address - Country:US
Mailing Address - Phone:331-250-9815
Mailing Address - Fax:
Practice Address - Street 1:1850 GATEWAY DR STE 100
Practice Address - Street 2:
Practice Address - City:SYCAMORE
Practice Address - State:IL
Practice Address - Zip Code:60178-3192
Practice Address - Country:US
Practice Address - Phone:815-217-3252
Practice Address - Fax:815-756-4941
Is Sole Proprietor?:No
Enumeration Date:2014-03-27
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA10216500207Q00000X
IL036141653207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine