Healthcare Provider Details

I. General information

NPI: 1073138277
Provider Name (Legal Business Name): ABRAHAM SAMIR KHEIREDDIN PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2020
Last Update Date: 01/24/2025
Certification Date: 01/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10330 S ROBERTS RD
PALOS HILLS IL
60465-1971
US

IV. Provider business mailing address

8346 MENARD AVE
BURBANK IL
60459-2658
US

V. Phone/Fax

Practice location:
  • Phone: 708-237-7200
  • Fax: 708-237-7201
Mailing address:
  • Phone: 708-263-7750
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085009053
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: