Individual
EJAZ AHMED KHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3922 MERCY DR, MCHENRY, IL 60050-3179
(815) 578-2020
(815) 344-3241
Mailing address
3922 MERCY DR, MCHENRY, IL 60050-3179
(815) 578-2020
(815) 344-3241
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036108886
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036108886
—
IL
01
—
1619414
BCBS GROUP
IL
05
—
3633309286030501
—
IL
Enumeration date
06/17/2006
Last updated
09/30/2015
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