Provider Demographics
NPI:1326216078
Name:WEDAD KHEDR, MD LTD
Entity Type:Organization
Organization Name:WEDAD KHEDR, MD LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:WEDAD
Authorized Official - Middle Name:
Authorized Official - Last Name:KHEDR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:815-544-7779
Mailing Address - Street 1:1907 CLOVERDALE WAY
Mailing Address - Street 2:
Mailing Address - City:BELVIDERE
Mailing Address - State:IL
Mailing Address - Zip Code:61008-7331
Mailing Address - Country:US
Mailing Address - Phone:815-544-7779
Mailing Address - Fax:
Practice Address - Street 1:1908 PIERCE CT
Practice Address - Street 2:
Practice Address - City:BELVIDERE
Practice Address - State:IL
Practice Address - Zip Code:61008-1742
Practice Address - Country:US
Practice Address - Phone:815-544-7779
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-15
Last Update Date:2008-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty