# 2001-15 N PARKSIDE LLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1518607696
- **Authorized official:** DR. MONA KHAN DO (PHYSICIAN)
- **Authorized official phone:** (312) 955-4005

## Contact information

- **Practice address:** 405 N WABASH AVE STE P2-A, CHICAGO, IL 60611-3744
- **Practice address phone:** (312) 955-4005
- **Mailing address:** 18140 AUDETTE ST, DEARBORN, MI 48124-4217
- **Mailing address phone:** (312) 998-5229

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261Q00000X | Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 03/29/2022
- **Last updated:** 03/29/2022