Individual
IMRAN KHAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
180 S 3RD ST, SUITE 300, BELLEVILLE, IL 62220-1952
(618) 233-5480
(618) 222-4790
Mailing address
180 S 3RD ST, BELLEVILLE, IL 62220-1952
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036145532
IL
207Q00000X
Family Medicine Physician
125067637
IL
Other
Enumeration date
06/17/2015
Last updated
04/29/2020
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