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Individual

MR. MAHAMID ALI KHAN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
DMD

Contact information

Practice address
6447 CERMAK RD, BERWYN, IL 60402-2311
(773) 254-1400
(312) 829-6375
Mailing address
966 W 21ST ST, CHICAGO, IL 60608-4511
(773) 254-1400
(312) 829-6375

Taxonomy

Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
019024670
IL
122300000X
Dentist
2005002250
MO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
019024670
IL
05
407262500
MO
Enumeration date
08/11/2005
Last updated
07/02/2021
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