Organization
ILLIANA PSYCHIATRIC ASSOCIATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. FARZANA A KHAN MD (CEO)
(219) 397-6369
Entity
Organization
Contact information
Practice address
2010 E COLUMBUS DR, EAST CHICAGO, IN 46312-2830
(219) 397-6369
Mailing address
4320 FIR ST, SUITE 307, EAST CHICAGO, IN 46312-3052
(219) 455-8155
Taxonomy
Speciality
Code
Description
License number
State
103TP0016X
Prescribing (Medical) Psychologist
Primary
1038685
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100325130
—
IN
Enumeration date
03/20/2013
Last updated
06/28/2019
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