Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 2901019237 | MI |
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 2901019237 | MI |
NPI | 1043385768 |
---|---|
Provider Name | Faisal Ali Khan |
First Address | Oak Lawn, IL 60453-2625 |
Second Address | Oak Lawn, IL 60453-2625 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/11/2006 |
Last Update Date | 22/02/2016 |