Healthcare Provider Details

I. General information

NPI: 1730642539
Provider Name (Legal Business Name): AYAH EL-KHATIB
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2019
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1969 W OGDEN AVE
CHICAGO IL
60612-3765
US

IV. Provider business mailing address

1969 W OGDEN AVE
CHICAGO IL
60612-3765
US

V. Phone/Fax

Practice location:
  • Phone: 312-864-0558
  • Fax: 312-864-9214
Mailing address:
  • Phone: 312-864-0558
  • Fax: 312-864-9214

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number036.159365
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036159365
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: