Provider Demographics
NPI:1568622744
Name:KHAN, SHEHWAR (MD)
Entity type:Individual
Prefix:
First Name:SHEHWAR
Middle Name:
Last Name:KHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SHEHWAR
Other - Middle Name:
Other - Last Name:ZIAUDDIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8530 MAJOR AVENUE
Mailing Address - Street 2:
Mailing Address - City:MORTON GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60053-3141
Mailing Address - Country:US
Mailing Address - Phone:312-933-1047
Mailing Address - Fax:
Practice Address - Street 1:8530 MAJOR AVENUE
Practice Address - Street 2:
Practice Address - City:MORTON GROVE
Practice Address - State:IL
Practice Address - Zip Code:60053-3141
Practice Address - Country:US
Practice Address - Phone:312-933-1047
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-11
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.120243207Q00000X
IL0361202432083X0100X
CAC172872207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL1742013Medicare UPIN
ILIL1742Medicare PIN