Individual
DR. NOURI AL-KHALED
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3545 W 95TH ST, EVERGREEN PARK, IL 60805-2135
(708) 346-5562
Mailing address
3545 W 95TH ST, EVERGREEN PARK, IL 60805-2135
(708) 346-5562
(708) 346-2059
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
036-096798
IL
207RI0011X
Interventional Cardiology Physician
036-096798
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0001619074
GROUP BC/BS
—
05
—
036096798
—
IL
01
—
161991361
GROUP NPI#
IL
01
—
685583
GROUP MEDICARE#
—
01
—
IL4013003
MEDICARE PTAN#
IL
01
—
IL4014003
MEDICARE PTAN#
IL
Enumeration date
07/10/2006
Last updated
12/20/2021
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