Individual
KHONDKER ISLAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1730 E LAKE SHORE DR, DECATUR, IL 62521-3809
(217) 329-1000
Mailing address
1730 E LAKE SHORE DR, DECATUR, IL 62521-3809
(217) 329-1000
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
036102111
IL
207RG0100X
Gastroenterology Physician
069489
GA
207RG0100X
Gastroenterology Physician
24098
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003133230A
—
GA
05
—
36102111
—
IL
Enumeration date
01/13/2006
Last updated
10/02/2024
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