Healthcare Provider Details

I. General information

NPI: 1306259817
Provider Name (Legal Business Name): KHALID NAVEED ARSHAD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2014
Last Update Date: 01/11/2021
Certification Date: 01/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 N WALL ST STE B402
KANKAKEE IL
60901-2940
US

IV. Provider business mailing address

400 N WALL ST STE B402
KANKAKEE IL
60901-2940
US

V. Phone/Fax

Practice location:
  • Phone: 815-937-1237
  • Fax: 815-933-0662
Mailing address:
  • Phone: 815-937-1237
  • Fax: 815-933-0662

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number036143983
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: