Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2084N0400X | Neurologist | 036.118844 | IL |
Y | 2084V0102X | Vascular Neurology | 036118844 | IL |
NPI | 1003014457 |
---|---|
Provider Name | Mr. Aslam Mohammed Khaja |
First Address | Lake Barrington, IL 60010-2538 |
Second Address | Lake Barrington, IL 60010-2538 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2007 |
Last Update Date | 23/03/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036118844 | (05) | IL |
20614135 | MEDICARE PTAN (INDIVIDUAL) (01) | IL |
206147 | MEDICARE PTAN (GROUP) (01) | IL |
P01144160 | RAILROAD MEDICARE INDIVIDUAL PTAN (01) | IL |