Healthcare Provider Details

I. General information

NPI: 1043147515
Provider Name (Legal Business Name): MAZEN KHUBIEH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2026
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8150 185TH ST STE A
TINLEY PARK IL
60487-9319
US

IV. Provider business mailing address

8150 185TH ST STE A
TINLEY PARK IL
60487-9319
US

V. Phone/Fax

Practice location:
  • Phone: 708-444-0444
  • Fax:
Mailing address:
  • Phone: 708-444-0444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number036.174993
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: