Provider Demographics
NPI:1205896974
Name:KHAN, ANILA (DO)
Entity type:Individual
Prefix:
First Name:ANILA
Middle Name:
Last Name:KHAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7061 N KEDZIE AVE STE 1402
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60645-2869
Mailing Address - Country:US
Mailing Address - Phone:224-508-8774
Mailing Address - Fax:224-298-0341
Practice Address - Street 1:825 E GOLF RD STE 1430
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005-5700
Practice Address - Country:US
Practice Address - Phone:224-508-8774
Practice Address - Fax:224-298-0341
Is Sole Proprietor?:No
Enumeration Date:2006-03-25
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036131409207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0185611Medicaid
IA080149738Medicare PIN
H07468Medicare UPIN
IA0185611Medicaid