Healthcare Provider Details

I. General information

NPI: 1093437105
Provider Name (Legal Business Name): MOHAMMAD KHADER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2022
Last Update Date: 04/21/2025
Certification Date: 04/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7124 W 83RD ST UNIT C
BRIDGEVIEW IL
60455-4034
US

IV. Provider business mailing address

9015 W 151ST ST UNIT A
ORLAND PARK IL
60462-3201
US

V. Phone/Fax

Practice location:
  • Phone: 708-424-0909
  • Fax: 708-424-1715
Mailing address:
  • Phone: 708-737-9724
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209025973
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: