Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 112917 | MO |
Y | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | 036104448 | IL |
NPI | 1790702322 |
---|---|
Provider Name | Dr. Fareesa G Khan |
First Address | Chicago, IL 60612-3833 |
Second Address | Chicago, IL 60612-3841 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2006 |
Last Update Date | 06/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
203820014 | (05) | MO |
I26188 | (02) |