Healthcare Provider Details

I. General information

NPI: 1265710388
Provider Name (Legal Business Name): AMER MOHAMMAD O. KHOJAH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2011
Last Update Date: 10/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 E CHICAGO AVE BOX 60
CHICAGO IL
60611-2991
US

IV. Provider business mailing address

401 E ONTARIO ST APT 3205
CHICAGO IL
60611-3051
US

V. Phone/Fax

Practice location:
  • Phone: 312-227-6010
  • Fax: 312-227-9401
Mailing address:
  • Phone: 202-499-9183
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number039.136029
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: