Islam, Khondker
Islam, Khondker is an individual health care provider with primary practice located at 1730 E Lake Shore Dr , Decatur IL 62521-3809. He recently has only one registered license in Allopathic & Osteopathic Physicians / Gastroenterology, which is considered as his primary health care specialty. Islam, Khondker can be contacted via phone (217) 329-1000.Contact Information
Primary practice address
1730 E Lake Shore Dr
Decatur IL 62521-3809
Phone: (217) 329-1000
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Gastroenterology | 207RG0100X | 069489 | Georgia |
| Allopathic & Osteopathic Physicians / Gastroenterology | 207RG0100X | 36102111 | Illinois |
| Allopathic & Osteopathic Physicians / Gastroenterology | 207RG0100X | 24098 | Mississippi |
Profile Details
| NPI number | 1568441855 |
|---|---|
| LBN Legal business name | Islam, Khondker |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jan 13th, 2006 |
| Last updated | Dec 30th, 2021 - about 4 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1568441855 | NPPES |
| Illinois | MEDICAID | 36102111 | |
| Illinois | MEDICAID | 003133230A |
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