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General NPI Number Information
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NPI Number | 1265627400
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Entity Type | Individual
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Provider Name | MOHEMAD RIZWAN KHALEEL M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/11/2007
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Last Update Date | 10/17/2017
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Provider Practice Location Address
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Address Line | 1600 TORRENCE AVE SUITE A
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City | CALUMET CITY
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State | IL
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Zip | 60409-5430
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Country | US
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Telephone | 708-891-0089
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Fax |
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Provider Business Mailing Address
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Address Line | 100 FOREST TRL
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City | OAK BROOK
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State | IL
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Zip | 60523-1411
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Country | US
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Telephone | 630-854-6683
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 036119244
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 036119244
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License Number State | IL
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