Healthcare Provider Details

I. General information

NPI: 1265465066
Provider Name (Legal Business Name): SARGON KHAMO M.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2006
Last Update Date: 03/18/2020
Certification Date: 03/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8118 N MILWAUKEE AVE STE 101
NILES IL
60714-2836
US

IV. Provider business mailing address

1337 LONDON LN
GLENVIEW IL
60025-2235
US

V. Phone/Fax

Practice location:
  • Phone: 847-696-7981
  • Fax:
Mailing address:
  • Phone: 847-544-6181
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number147001080
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: