Provider Demographics
NPI:1538105911
Name:KHUDEIRA, ABDULKAREEM (MD)
Entity Type:Individual
Prefix:DR
First Name:ABDULKAREEM
Middle Name:
Last Name:KHUDEIRA
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 1:9405 S OKETO AVE
Mailing Address - Street 2:
Mailing Address - City:BRIDGEVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60455-2140
Mailing Address - Country:US
Mailing Address - Phone:773-585-0480
Mailing Address - Fax:
Practice Address - Street 1:8071 S CICERO AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60652-2003
Practice Address - Country:US
Practice Address - Phone:773-585-0480
Practice Address - Fax:773-585-0482
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036085737207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILDV7404OtherRAILROAD GRP
IL036085737Medicaid
IL016331133OtherBCBS
ILIL8043OtherMEDICARE GRP
ILIL8043001OtherMEDICARE IND
ILP00183246OtherRAILROAD IND
IL016331133OtherBCBS
ILDV7404OtherRAILROAD GRP