Healthcare Provider Details

I. General information

NPI: 1386112555
Provider Name (Legal Business Name): MOHAMMED KHAIR ALGHABRA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2018
Last Update Date: 12/21/2022
Certification Date: 12/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1675 DEMPSTER ST
PARK RIDGE IL
60068-1110
US

IV. Provider business mailing address

29373 NETWORK PL
CHICAGO IL
60673-1110
US

V. Phone/Fax

Practice location:
  • Phone: 847-318-9300
  • Fax: 847-723-9051
Mailing address:
  • Phone: 847-390-5900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036-157025
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: