Individual
SHADAB ALI KHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5666 E STATE ST, ROCKFORD, IL 61108-2425
(815) 227-2512
(779) 227-6158
Mailing address
3714 PEREGRINE WAY, ELGIN, IL 60124-7880
(585) 489-9524
Taxonomy
Speciality
Code
Description
License number
State
2085R0204X
Vascular & Interventional Radiology Physician
Primary
036143740
IL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/06/2014
Last updated
05/26/2026
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