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General NPI Number Information
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NPI Number | 1548170913
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Entity Type | Organization
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Legal Business Name | MED SPA OF MT GREENWOOD PLLC
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Dates
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Enumeration Date | 09/09/2026
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Last Update Date | 09/09/2026
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Provider Practice Location Address
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Address Line | 10301 S KEDZIE AVE UNIT A
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City | CHICAGO
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State | IL
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Zip | 60655-2015
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Country | US
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Telephone | 708-374-0118
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Fax |
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Provider Business Mailing Address
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Address Line | 10301 S KEDZIE AVE UNIT A
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City | CHICAGO
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State | IL
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Zip | 60655-2015
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Country | US
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Telephone | 708-374-0118
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | KHADER ZAHDAN
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Credential | DO
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Telephone | 708-374-0118
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QI0500X
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Taxonomy Name | Infusion Therapy Clinic/Center
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License Number |
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License Number State |
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