Healthcare Provider Details

I. General information

NPI: 1821550880
Provider Name (Legal Business Name): RAMZY CHARLES KHABBAZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2019
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 SILVER CROSS BLVD
NEW LENOX IL
60451-9509
US

IV. Provider business mailing address

1240 N LAKE SHORE DR APT 21B
CHICAGO IL
60610-6650
US

V. Phone/Fax

Practice location:
  • Phone: 309-740-4272
  • Fax:
Mailing address:
  • Phone: 708-228-8659
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number036.173766
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: