Healthcare Provider Details

I. General information

NPI: 1720332703
Provider Name (Legal Business Name): KHUDEIRA MEDICAL CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2012
Last Update Date: 02/01/2019
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 Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ABDULKAREEM KHUDEIRA
Title or Position: OWNER
Credential: MD
Phone: 773-585-0480