Individual
MAAN SAMI EL KHADRA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1901 W HARRISON ST, CHICAGO, IL 60612-3714
(312) 864-3036
(312) 864-9349
Mailing address
1901 W HARRISON ST, CHICAGO, IL 60612-3714
(312) 864-3036
(312) 864-9349
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
036073394
IL
207RC0000X
Cardiovascular Disease Physician
36-073394
IL
207RC0000X
Cardiovascular Disease Physician
Primary
66630
MN
207RI0011X
Interventional Cardiology Physician
036073394
IL
2085R0204X
Vascular & Interventional Radiology Physician
36-073394
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01621175
BCBS
IL
05
—
036073394
—
IL
01
—
630001349
RR MIA
IL
Enumeration date
07/18/2005
Last updated
01/06/2023
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