Complete Child Health

Primary specialty

Pediatric Adolescent Medicine PhysicianTaxonomy code 2080A0000X

License

036109931 Issued in IL

Legal business name

COMPLETE CHILD HEALTH

Practice address

498 W Boughton Rd
Suite 102
Bolingbrook, IL 60440-1893

Phone

(630) 771-1630

Fax

(630) 771-1631

NPI assigned

Jul 2, 2010

Organization subpart

No

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

Authorized official

Name

Dr. Mohammad Mahmud Khan, MD

Title

Pediatrician

Phone

(630) 771-1630

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1278028800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1278028800000",
    "number": "1801108188",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "498 W BOUGHTON RD",
            "address_2": "SUITE 102",
            "city": "BOLINGBROOK",
            "state": "IL",
            "postal_code": "604401893",
            "telephone_number": "630-771-1630",
            "fax_number": "630-771-1631"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "498 W BOUGHTON RD",
            "address_2": "SUITE 102",
            "city": "BOLINGBROOK",
            "state": "IL",
            "postal_code": "604401893",
            "telephone_number": "630-771-1630",
            "fax_number": "630-771-1631"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMPLETE CHILD HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-07-02",
        "last_updated": "2010-07-02",
        "status": "A",
        "authorized_official_last_name": "KHAN",
        "authorized_official_first_name": "MOHAMMAD",
        "authorized_official_middle_name": "MAHMUD",
        "authorized_official_title_or_position": "PEDIATRICIAN",
        "authorized_official_telephone_number": "630-771-1630",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2080A0000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Pediatrics, Adolescent Medicine",
            "state": "IL",
            "license": "036109931",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036109931",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Pediatric Adolescent Medicine Physician in Bolingbrook, IL
• Providers in Bolingbrook, IL by specialty
• Pediatric Adolescent Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.