Provider Demographics
NPI:1487696126
Name:KHAISER, NOOR A (MD)
Entity type:Individual
Prefix:DR
First Name:NOOR
Middle Name:A
Last Name:KHAISER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3315 N SEMINARY ST
Mailing Address - Street 2:
Mailing Address - City:GALESBURG
Mailing Address - State:IL
Mailing Address - Zip Code:61401-1251
Mailing Address - Country:US
Mailing Address - Phone:309-344-1000
Mailing Address - Fax:309-344-2405
Practice Address - Street 1:3315 N SEMINARY ST
Practice Address - Street 2:
Practice Address - City:GALESBURG
Practice Address - State:IL
Practice Address - Zip Code:61401-1251
Practice Address - Country:US
Practice Address - Phone:309-344-1000
Practice Address - Fax:309-344-2405
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036060635207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL0110OtherJOHN DEERE
IL036060635Medicaid
IL5159329OtherAETNA HEALTH PLANS
IL776530OtherMEDICARE GROUP NUMBER
IL100010089OtherRAILROAD MEDICARE
IL169319OtherHEALTHLINK
IL371221637OtherFEDERAL TAX IDENTIFICATIO
IL008990OtherHEALTH ALLIANCE
IL07215152OtherBLUE CROSS
IL07215152OtherBLUE CROSS
IL008990OtherHEALTH ALLIANCE