Healthcare Provider Details

I. General information

NPI: 1487055133
Provider Name (Legal Business Name): SAM KHALILI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2014
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

880 W CENTRAL RD STE 7200
ARLINGTON HEIGHTS IL
60005-2382
US

IV. Provider business mailing address

2650 RIDGE AVE STE 1223
EVANSTON IL
60201-1700
US

V. Phone/Fax

Practice location:
  • Phone: 847-618-4430
  • Fax: 847-618-0786
Mailing address:
  • Phone: 847-570-2040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number64697
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number036159776
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: