Provider Demographics
NPI:1235144643
Name:KHATOON, HUMAIRA (MD)
Entity type:Individual
Prefix:
First Name:HUMAIRA
Middle Name:
Last Name:KHATOON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:431 SUMMIT STREET
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60120
Mailing Address - Country:US
Mailing Address - Phone:847-289-8822
Mailing Address - Fax:847-289-0815
Practice Address - Street 1:431 SUMMIT STREET
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60120
Practice Address - Country:US
Practice Address - Phone:847-289-8822
Practice Address - Fax:847-289-0815
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036095004207L00000X
IL36095004207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL7200026Medicaid
IL036095004OtherSTATE LICENSE
ILP01156622OtherRAILROAD MEDICARE
ILIL7200026Medicaid
ILIL7200026Medicaid