Individual
KHALED MITWALLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
751 N RUTLEDGE ST RM 1100, SPRINGFIELD, IL 62702-4968
(217) 545-8000
Mailing address
PO BOX 19636, SPRINGFIELD, IL 62794-9636
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
125.088049
IL
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
05/29/2026
Last updated
06/08/2026
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