Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | 036140125 | IL |
NPI | 1033552179 |
---|---|
Provider Name | Dr. Ruben Hasan Khan |
First Address | Burr Ridge, IL 60527-5968 |
Second Address | Chicago, IL 60637-1443 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/04/2013 |
Last Update Date | 30/06/2019 |