Provider Demographics
NPI:1871546879
Name:MIDWEST INSTITUTE OF ARTHRITIS AND MEDICINE
Entity type:Organization
Organization Name:MIDWEST INSTITUTE OF ARTHRITIS AND MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GOWHAR
Authorized Official - Middle Name:A
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-801-7505
Mailing Address - Street 1:1177 N HIGHLAND AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60506-2281
Mailing Address - Country:US
Mailing Address - Phone:630-801-7505
Mailing Address - Fax:
Practice Address - Street 1:1177 N HIGHLAND AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60506-2281
Practice Address - Country:US
Practice Address - Phone:630-801-7505
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207R00000X, 207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Not Answered207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL529160Medicare ID - Type Unspecified