Basic Information
Provider Information
NPI: 1003014457
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: KHAJA
FirstName: ASLAM
MiddleName: MOHAMMED
NamePrefix: MR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 22285 N PEPPER RD
Address2: SUITE 401
City: LAKE BARRINGTON
State: IL
PostalCode: 600102538
CountryCode: US
TelephoneNumber: 8478826604
FaxNumber: 8478826228
Practice Location
Address1: 22285 N PEPPER RD
Address2: SUITE 401
City: LAKE BARRINGTON
State: IL
PostalCode: 600102538
CountryCode: US
TelephoneNumber: 8478826604
FaxNumber: 8478826228
Other Information
ProviderEnumerationDate: 07/06/2007
LastUpdateDate: 03/23/2017
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2084N0400X036.118844ILN Allopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
2084V0102X036118844ILY Allopathic & Osteopathic PhysiciansPsychiatry & NeurologyVascular Neurology

ID Information
IDTypeStateIssuerDescription
P0114416001ILRAILROAD MEDICARE INDIVIDUAL PTANOTHER
03611884405IL MEDICAID
20614701ILMEDICARE PTAN (GROUP)OTHER
2061413501ILMEDICARE PTAN (INDIVIDUAL)OTHER


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