Provider Demographics
NPI:1588070031
Name:AL-KHAFAJI, KHALID (MD)
Entity type:Individual
Prefix:
First Name:KHALID
Middle Name:
Last Name:AL-KHAFAJI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:624 SHERIDAN RD
Mailing Address - Street 2:APT# 3A
Mailing Address - City:HIGHWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60040-1055
Mailing Address - Country:US
Mailing Address - Phone:832-450-1101
Mailing Address - Fax:
Practice Address - Street 1:2160 S 1ST AVE
Practice Address - Street 2:
Practice Address - City:MAYWOOD
Practice Address - State:IL
Practice Address - Zip Code:60153-3328
Practice Address - Country:US
Practice Address - Phone:708-216-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-05
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125.065337207R00000X
IN01085781A207RC0000X
IL036.142953208M00000X
IL036142953207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist