Shahreq Ali Khan, BACHELOR OF SCIENCE
Clinic/Center in Gurnee, IL. Individual provider (NPI-1).
NPI number1811656028
StatusActive
Last updated in NPPESFeb 8, 2022
Details
- NPI
- 1811656028
- Entity type
- Individual (NPI-1)
- Name
- Shahreq Ali Khan
- Credential
- BACHELOR OF SCIENCE
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Dec 15, 2021
- Certification date
- Feb 8, 2022
- Last updated
- Feb 8, 2022
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261Q00000X | Clinic/Center | 14D2250825 | IL | Yes |
Practice location
3949 Grove AveGurnee, IL 60031-2118
Phone 224-202-7777
Mailing address
3949 Grove AveGurnee, IL 60031-2118
Phone 224-202-7777
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