Provider Demographics
NPI:1285380758
Name:ABDULATEEF, KHALID
Entity type:Individual
Prefix:
First Name:KHALID
Middle Name:
Last Name:ABDULATEEF
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 W THRUSH AVE
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61604-3347
Mailing Address - Country:US
Mailing Address - Phone:309-444-6310
Mailing Address - Fax:
Practice Address - Street 1:2001 S JONES BLVD STE E3
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-3165
Practice Address - Country:US
Practice Address - Phone:702-425-3377
Practice Address - Fax:702-997-7552
Is Sole Proprietor?:No
Enumeration Date:2022-02-23
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant