Khaled Aboushaala
Individual provider Active NPI Surgical Physician Assistant · Mokena, IL
NPI 1659226306 · NPPES record last updated Feb 27, 2026
Key facts
- NPI
- 1659226306
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Surgical Physician Assistant 363AS0400X
- License
- 238.010972 (IL)
- Practice address
- 19015 S Jodi Rd Ste H
Mokena, IL 60448-8534 - Phone
- (708) 994-5418
- Fax
- (832) 804-8886
- NPI assigned
- Feb 27, 2026
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 238.010972 | IL | MD | Surgical Physician Assistant |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgical Assistant | 246ZC0007X | 238.010972 | IL | |
| Surgical Physician Assistant | 363AS0400X | 238.010972 | IL | Yes |
Addresses
Primary practice location
19015 S Jodi Rd Ste H
Mokena, IL 60448-8534
Mailing address
19015 S Jodi Rd Ste H
Mokena, IL 60448-8534
Phone (708) 994-5418
Other providers in Mokena, IL
- A-Advance Ambulance LLC
- A-Advantage Ambulance LLC
- Kathryn E Aardema
- ABA Laboratory
- Deena Ashraf Abousedu
- Absolute Vision Care II LTD
- Dima Abuosba
- Accelerated Rehabilitation Centers, LTD
- Accelerated Rehabilitation Centers, LTD
- Francisco Acevedo Jr.
All providers in Mokena, IL · Surgical Physician Assistant in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 27, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.