Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | 016004550 | IL |
NPI | 1053341305 |
---|---|
Provider Name | Iqbal H Khan II |
First Address | Mchenry, IL 60050-4214 |
Second Address | Mchenry, IL 60050-4214 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2006 |
Last Update Date | 21/05/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U21715 | (02) | IL |