Active NPI
Nicole Khoshaba, OD
- Student in an Organized Health Care Education/Training Program
- Northbrook, IL
National Provider Identifier
1336068675
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Student in an Organized Health Care Education/Training Program
- License
- 046.012111
- Practice address
- 2230 Northbrook CT
Northbrook, IL 60062-1408 - Phone
- (847) 564-0020
- NPI assigned
- Jul 13, 2026
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | 046.012111 | IL | Primary |
Addresses
Primary practice location
2230 Northbrook CT
Northbrook, IL 60062-1408
Mailing address
9235 Marmora Ave
Morton Grove, IL 60053-1509
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1783900800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1783900800000",
"number": "1336068675",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9235 MARMORA AVE",
"city": "MORTON GROVE",
"state": "IL",
"postal_code": "600531509"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2230 NORTHBROOK CT",
"city": "NORTHBROOK",
"state": "IL",
"postal_code": "600621408",
"telephone_number": "847-564-0020"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KHOSHABA",
"first_name": "NICOLE",
"credential": "OD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2026-07-13",
"last_updated": "2026-07-13",
"certification_date": "2026-06-30",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": "IL",
"license": "046.012111",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Northbrook, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.