Provider Demographics
NPI:1144271206
Name:KHAYAL, HOSAM N (MD)
Entity type:Individual
Prefix:
First Name:HOSAM
Middle Name:N
Last Name:KHAYAL
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 1:1800 E LAKE SHORE DR
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62521-3810
Mailing Address - Country:US
Mailing Address - Phone:217-464-5811
Mailing Address - Fax:217-464-1318
Practice Address - Street 1:1740 W TAYLOR ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-7232
Practice Address - Country:US
Practice Address - Phone:312-492-2706
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-13
Last Update Date:2025-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01065886A207R00000X, 208M00000X
IL036113434207R00000X, 208M00000X, 207RH0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000883080OtherANTHEM
IN200926870Medicaid
IL036113434Medicaid
IN000000612789OtherANTHEM
IN000000612789OtherBCBS
IL036113434Medicaid
ILK26143Medicare ID - Type UnspecifiedFEE SCHEDULE LOCALITY 16
IN941050ZZZMedicare PIN