Healthcare Provider Details

I. General information

NPI: 1538105911
Provider Name (Legal Business Name): ABDULKAREEM KHUDEIRA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8071 S CICERO AVE
CHICAGO IL
60652-2003
US

IV. Provider business mailing address

9405 S OKETO AVE
BRIDGEVIEW IL
60455-2140
US

V. Phone/Fax

Practice location:
  • Phone: 773-585-0480
  • Fax: 773-585-0482
Mailing address:
  • Phone: 773-585-0480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036085737
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: