MEDICARE: THAMIR RIAD KHADER M.D

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	2084P0800X	Psychiatry Physician	036.175714	IL

General Provider Information

NPI Number	:	1700428000
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THAMIR RIAD KHADER M.D

Provider Business Mailing Address
First Line	:	5343 BELLEVILLE CROSSING ST UNIT 450
Second Line	:
City	:	BELLEVILLE
State	:	IL
Zip	:	62226-3108
Country	:	US
Telephone Number	:	708-247-5487
Fax Number	:

Provider Business Practice Location Address
First Line	:	5343 BELLEVILLE CROSSING ST UNIT 450
Second Line	:
City	:	BELLEVILLE
State	:	IL
Zip	:	62226-3108
Country	:	US
Telephone Number	:	708-247-5487
Fax Number	:

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

Provider Enumeration Date	:	10/08/2019
Last Update Date	:	02/18/2026

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