Individual
DR. RUSSELL I KHATER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1106 N LARKIN AVE, LOWER LEVEL, JOLIET, IL 60435-3455
(815) 725-6188
(815) 741-1541
Mailing address
1106 N LARKIN AVE, LOWER LEVEL, JOLIET, IL 60435-3455
(815) 725-6188
(815) 741-1541
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
036098419
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036041596
—
IL
Enumeration date
12/05/2006
Last updated
10/31/2016
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