Individual provider Active NPI

Abdur R Khan, MD

  • Infectious Disease Physician
  • Milwaukee, WI
National Provider Identifier
1780675439
Registry record updated Oct 20, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Infectious Disease PhysicianTaxonomy code 207RI0200X
License
69966 Issued in WI
Practice address
2901 W Kinnickinnic River Pkwy
Milwaukee, WI 53215-3677
Phone
(414) 646-8990
Fax
(414) 646-8995
NPI assigned
Nov 2, 2005
Last updated
Oct 20, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 20, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 35089520 OH
Internal Medicine Physician 207R00000X 21760 WV
Infectious Disease Physician 207RI0200X 69966 WI Primary

Addresses

Primary practice location

2901 W Kinnickinnic River Pkwy
Milwaukee, WI 53215-3677

Mailing address

PO Box 735044
Chicago, IL 60673-5044

Other practice location 1

2200 Philadelphia Dr
Suite 644
Dayton, OH 45406-1840
Phone (937) 278-6874

Other practice location 2

1818 N Meade St Ste 130
Appleton, WI 54911
Phone (920) 831-1841

Other identifiers 3

IdentifierTypeStateIssuer
100081242MedicaidWI
3810002265MedicaidWV
2767840MedicaidOH

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address akhan380875@direct.myadvocateaurora.org Direct
FHIR URL https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH, WI2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20070622000257 OH Practitioner - Internal MedicinePractitioner - Infectious Disease 4688625296 Reassigns benefits to 1 organization
I20180927000541 WI Practitioner - Infectious Disease 4688625296 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Infectious Disease
Education
Other, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Lakeshore Medical Clinic LLCGroup PAC ID 7719890730, 375 clinicians

Practice addresses (Care Compare)

2901 W Kinnickinnic River Pkwy
Milwaukee, WI 53215-3660
Phone (414) 646-8995

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
35089520OHMDInternal Medicine Physician
21760WVMDInternal Medicine Physician
69966WIMDInfectious Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Lakeshore Medical Clinic, LLC CurrentSince Aug 25, 2023 Accepting new patients
Premier Health Specialists Inc Internal Medicine CurrentSince Jul 10, 2012 Accepting new patients
Aurora Advanced Healthcare, Inc. Internal Medicine CurrentSince Apr 15, 2025 Accepting new patients
Aurora Medical Group, Inc. CurrentSince Apr 15, 2025 Accepting new patients
Aurora Medical Group, Inc. Internal Medicine Current Accepting new patients
Aurora Advanced Healthcare Inc CurrentSince Apr 15, 2025 Accepting new patients
Aurora Medical Group, Inc. CurrentSince Apr 15, 2025 Accepting new patients
Premier Health Specialists Inc CurrentSince Jul 10, 2012 Accepting new patients
Dayton Lung and Sleep Medicine Inc Past Accepting new patients

Locations

30 E Apple St
#6258
Dayton, OH 45409
Phone (937) 208-5300

3170 Kettering Blvd
Bldg B
Moraine, OH 45439
Phone (937) 991-3187

450 N Hyatt St
Ste 304
Tipp City, OH 45371
Phone (937) 832-4773

1818 N Meade St
Ste 130
Appleton, WI 54911
Phone (920) 410-7310

3003 W Good Hope Rd
Glendale, WI 53209
Phone (414) 352-3100

12203 N Corporate Pkwy
Mequon, WI 53092
Phone (262) 387-8200

1020 N 12th St
Milwaukee, WI 53233
Phone (414) 219-3056

2900 W Oklahoma Ave
Milwaukee, WI 53215
Phone (414) 385-2590

2901 W Kinnickinnic River Pkwy
Milwaukee, WI 53215
Phone (414) 385-3084

2901 W Kinnickinnic River Pkwy
Ste 200
Milwaukee, WI 53215
Phone (414) 646-8995

S74W16775 Janesville Rd
Muskego, WI 53150
Phone (414) 422-4747

2000 E Layton Ave
St Francis, WI 53235
Phone (414) 744-7880

Interoperability endpoints

  • Direct secure messaging: akhan191886@direct.thedacare.org
  • Direct secure messaging: akhan380875@direct.myadvocateaurora.org

Organizations & group practices 9

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1130889600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1697760000000",
    "number": "1780675439",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 735044",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606735044"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2901 W KINNICKINNIC RIVER PKWY",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532153677",
            "telephone_number": "414-646-8990",
            "fax_number": "414-646-8995"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2200 Philadelphia Dr",
            "address_2": "Suite 644",
            "address_purpose": "LOCATION",
            "city": "Dayton",
            "state": "OH",
            "postal_code": "454061840",
            "country_code": "US",
            "telephone_number": "937-278-6874",
            "fax_number": "937-278-7201",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1818 N Meade St Ste 130",
            "address_purpose": "LOCATION",
            "city": "Appleton",
            "state": "WI",
            "postal_code": "54911",
            "country_code": "US",
            "telephone_number": "920-831-1841",
            "fax_number": "920-831-1834",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KHAN",
        "first_name": "ABDUR",
        "middle_name": "R",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-02",
        "last_updated": "2023-10-20",
        "certification_date": "2023-10-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OH",
            "license": "35089520",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "WV",
            "license": "21760",
            "primary": false
        },
        {
            "code": "207RI0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Infectious Disease",
            "state": "WI",
            "license": "69966",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100081242",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3810002265",
            "state": "WV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2767840",
            "state": "OH"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "akhan380875@direct.myadvocateaurora.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "2901 W Kinnickinnic River Pkwy",
            "city": "Milwaukee",
            "state": "WI",
            "country_code": "US",
            "postal_code": "532153677",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "2901 W Kinnickinnic River Pkwy",
            "city": "Milwaukee",
            "state": "WI",
            "country_code": "US",
            "postal_code": "532153677",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Milwaukee, WI

Sources for this page

Verify at the official NPI Registry.