Provider Demographics
NPI:1326667304
Name:KHAZOUM, ELIAS SALIM
Entity Type:Individual
Prefix:
First Name:ELIAS
Middle Name:SALIM
Last Name:KHAZOUM
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 1:1124 LAKE ST UNIT 605
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60301-1378
Mailing Address - Country:US
Mailing Address - Phone:217-840-2315
Mailing Address - Fax:
Practice Address - Street 1:20201 S. CRAWFORD AVE
Practice Address - Street 2:ATTN: POSTDOCTORAL EDUCATION
Practice Address - City:OLYMPIA FIELDS
Practice Address - State:IL
Practice Address - Zip Code:60461
Practice Address - Country:US
Practice Address - Phone:708-747-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-10
Last Update Date:2020-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program