MEDICARE: KHUDEIRA MEDICAL CENTER, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QU0200X	Urgent Care Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1720332703
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KHUDEIRA MEDICAL CENTER, INC

Provider Business Mailing Address
First Line	:	9405 S OKETO AVE
Second Line	:
City	:	BRIDGEVIEW
State	:	IL
Zip	:	60455-2140
Country	:	US
Telephone Number	:	773-585-0480
Fax Number	:

Provider Business Practice Location Address
First Line	:	8071 S CICERO AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60652-2003
Country	:	US
Telephone Number	:	773-585-0480
Fax Number	:	773-585-0482

Authorized Official
Title or Position	:	OWNER
Name	:	ABDULKAREEM KHUDEIRA
Credential	:	MD
Telephone Number	:	773-585-0480

Provider Enumeration Date	:	10/30/2012
Last Update Date	:	02/01/2019

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