Provider Demographics
NPI:1023306230
Name:EL-KHABIRY, EHAB (MD)
Entity type:Individual
Prefix:DR
First Name:EHAB
Middle Name:
Last Name:EL-KHABIRY
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 1:2605 S INDIANA AVE
Mailing Address - Street 2:APT 1704
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616-2849
Mailing Address - Country:US
Mailing Address - Phone:815-319-3398
Mailing Address - Fax:
Practice Address - Street 1:2605 S INDIANA AVE
Practice Address - Street 2:APT 1704
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616
Practice Address - Country:US
Practice Address - Phone:815-319-3398
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-21
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI186207R00000X
IL036-135959207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV100080301Medicaid