Provider Demographics
NPI:1922701143
Name:KHRISAT, NOUREDEAN (DO)
Entity type:Individual
Prefix:
First Name:NOUREDEAN
Middle Name:
Last Name:KHRISAT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:DEAN
Other - Middle Name:
Other - Last Name:KHRISAT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:8629 MCVICKER AVE
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:IL
Mailing Address - Zip Code:60459-2511
Mailing Address - Country:US
Mailing Address - Phone:708-238-1227
Mailing Address - Fax:
Practice Address - Street 1:550 UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-5149
Practice Address - Country:US
Practice Address - Phone:317-274-0275
Practice Address - Fax:317-274-0256
Is Sole Proprietor?:No
Enumeration Date:2023-03-27
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program