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1316946700

NPI Code Detail

MEDICARE: MAAN SAMI EL KHADRA MD

MEDICARE: MAAN SAMI EL KHADRA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician	036073394	IL
2	207RC0000X	Cardiovascular Disease Physician	36-073394	IL
3	207RI0011X	Interventional Cardiology Physician	036073394	IL
4	2085R0204X	Vascular & Interventional Radiology Physician	36-073394	IL
5	207RC0000X	Cardiovascular Disease Physician	66630	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	01621175	OTHER	IL	BCBS
2	630001349	OTHER	IL	RR MIA
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1316946700
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAAN SAMI EL KHADRA MD

Provider Business Mailing Address
First Line	:	1901 W HARRISON ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60612-3714
Country	:	US
Telephone Number	:	312-864-3036
Fax Number	:	312-864-9349

Provider Business Practice Location Address
First Line	:	1901 W HARRISON ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60612-3714
Country	:	US
Telephone Number	:	312-864-3036
Fax Number	:	312-864-9349

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/18/2005
Last Update Date	:	01/06/2023

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Directions to “ MAAN SAMI EL KHADRA MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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