Healthcare Provider Details

I. General information

NPI: 1235691684
Provider Name (Legal Business Name): MOBIN KHEIRKHAHAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2019
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2160 S 1ST AVE RM 6292
MAYWOOD IL
60153-3328
US

IV. Provider business mailing address

2160 S 1ST AVE RM 6292
MAYWOOD IL
60153-3328
US

V. Phone/Fax

Practice location:
  • Phone: 708-216-5911
  • Fax: 708-327-2771
Mailing address:
  • Phone: 708-216-5911
  • Fax: 708-327-2771

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberT-3953
License Number StateMS
# 3
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number036.180749
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number036.180749
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: