Provider Demographics
NPI:1083821565
Name:ATIEH, OSAMA KHAIRY (MD)
Entity Type:Individual
Prefix:
First Name:OSAMA
Middle Name:KHAIRY
Last Name:ATIEH
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 1:12050 S HARLEM AVE
Mailing Address - Street 2:UNIT B
Mailing Address - City:PALOS HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60463-1470
Mailing Address - Country:US
Mailing Address - Phone:708-361-5788
Mailing Address - Fax:708-361-5508
Practice Address - Street 1:12050 S HARLEM AVE
Practice Address - Street 2:UNIT B
Practice Address - City:PALOS HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60463-1470
Practice Address - Country:US
Practice Address - Phone:708-361-5788
Practice Address - Fax:708-361-5508
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036086966207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036086966Medicaid
IL211713Medicare ID - Type Unspecified
IL036086966Medicaid