Individual
DR. MANSOOR KHAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
800 BIESTERFIELD RD # 407, ELK GROVE VILLAGE, IL 60007-3311
(847) 952-7181
(847) 437-8824
Mailing address
PO BOX 7077, VILLA PARK, IL 60181-7077
(847) 952-7181
(847) 437-8824
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
036-093169
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110189123
RAILROAD MEDICARE
IL
01
—
364302965
TAX IDENTIFICATION NUMBER
IL
Enumeration date
11/03/2006
Last updated
04/08/2009
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