Provider Demographics
NPI:1053341305
Name:KHAN, IQBAL H II (DPM)
Entity type:Individual
Prefix:
First Name:IQBAL
Middle Name:H
Last Name:KHAN
Suffix:II
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4310 W CRYSTAL LAKE RD
Mailing Address - Street 2:SUITE F
Mailing Address - City:MCHENRY
Mailing Address - State:IL
Mailing Address - Zip Code:60050-4214
Mailing Address - Country:US
Mailing Address - Phone:815-363-3223
Mailing Address - Fax:815-363-3240
Practice Address - Street 1:4310 W CRYSTAL LAKE RD
Practice Address - Street 2:SUITE F
Practice Address - City:MCHENRY
Practice Address - State:IL
Practice Address - Zip Code:60050-4214
Practice Address - Country:US
Practice Address - Phone:815-363-3223
Practice Address - Fax:815-363-3240
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2015-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016004550213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILU21715Medicare UPIN
IL365130Medicare ID - Type Unspecified