Provider Demographics
NPI:1558477661
Name:KHILFEH, HAMDI MANSOUR (MD)
Entity Type:Individual
Prefix:DR
First Name:HAMDI
Middle Name:MANSOUR
Last Name:KHILFEH
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 1:2955 W. 95TH ST
Mailing Address - Street 2:
Mailing Address - City:EVERGREEN PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60805-2004
Mailing Address - Country:US
Mailing Address - Phone:708-422-1363
Mailing Address - Fax:708-422-1256
Practice Address - Street 1:2955 W. 95TH ST
Practice Address - Street 2:
Practice Address - City:EVERGREEN PARK
Practice Address - State:IL
Practice Address - Zip Code:60805-2004
Practice Address - Country:US
Practice Address - Phone:708-422-1363
Practice Address - Fax:708-422-1256
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL110790207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL123653Medicare UPIN