Mohammad Awad Al Khudari, MD
Individual provider Active NPI Obstetrics & Gynecology Physician · New Lenox, IL
NPI 1720151624 · NPPES record last updated May 1, 2012
Key facts
- NPI
- 1720151624
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Obstetrics & Gynecology Physician 207V00000X
- License
- 036051013 (IL)
- Practice address
- 1890 Silver Cross Blvd
Suite 330
New Lenox, IL 60451-9508 - Phone
- (815) 717-6082
- Fax
- (815) 717-8693
- NPI assigned
- Nov 16, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036051013 | IL | MD | Obstetrics & Gynecology Physician |
| 3651013 | IL | MD | Obstetrics & Gynecology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mohammad Alkhudari LTD | Obstetrics & Gynecology | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Obstetrics & Gynecology Physician | 207V00000X | 3651013 | IL | |
| Obstetrics & Gynecology Physician | 207V00000X | 036051013 | IL | Yes |
Addresses
Primary practice location
1890 Silver Cross Blvd
Suite 330
New Lenox, IL 60451-9508
Mailing address
1890 Silver Cross Blvd
Suite 330
New Lenox, IL 60451-9508
Phone (815) 717-6082
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 036051013 | Medicaid | IL |
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 1, 2012. 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.