Provider Demographics
NPI:1588677967
Name:KHATIB, NAZIH B (MD)
Entity Type:Individual
Prefix:DR
First Name:NAZIH
Middle Name:B
Last Name:KHATIB
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 1:6021 S KEDZIE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60629-3304
Mailing Address - Country:US
Mailing Address - Phone:773-776-5330
Mailing Address - Fax:773-776-5350
Practice Address - Street 1:6021 S KEDZIE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60629-3304
Practice Address - Country:US
Practice Address - Phone:773-776-5330
Practice Address - Fax:773-776-5350
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036097389208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0001622181OtherBCBS PROVIDER #
IL036097389Medicaid