Individual
AMBAREEN KHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
820 S DAMEN AVE, CHICAGO, IL 60612-3728
(312) 569-8387
Mailing address
820 S DAMEN AVE, CHICAGO, IL 60612-3728
(312) 569-8387
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
036140766
IL
208M00000X
Hospitalist Physician
Primary
036140766
IL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
206147
MEDICARE PTAN GROUP
IL
01
—
F400310838
MEDICARE PTAN INDIVIDUAL
IL
Enumeration date
03/21/2013
Last updated
03/02/2019
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