Healthcare Provider Details

I. General information

NPI: 1023462280
Provider Name (Legal Business Name): BAHIJ KREIDIEH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2016
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3545 W 95TH ST
EVERGREEN PARK IL
60805-2135
US

IV. Provider business mailing address

100 E LANCASTER AVE
WYNNEWOOD PA
19096-3450
US

V. Phone/Fax

Practice location:
  • Phone: 708-346-5562
  • Fax: 708-346-2059
Mailing address:
  • Phone: 844-762-6824
  • Fax: 561-548-1572

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number80790
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number036166973
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: