Provider Demographics
NPI:1730541384
Name:HAMA MEDICAL GROUP LTD
Entity type:Organization
Organization Name:HAMA MEDICAL GROUP LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HAMDI
Authorized Official - Middle Name:
Authorized Official - Last Name:KHILFEH
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:708-200-6615
Mailing Address - Street 1:2955 W 95TH ST
Mailing Address - Street 2:
Mailing Address - City:EVERGREEN PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60805-2409
Mailing Address - Country:US
Mailing Address - Phone:708-422-1363
Mailing Address - Fax:708-422-1256
Practice Address - Street 1:2955 W 95TH ST
Practice Address - Street 2:
Practice Address - City:EVERGREEN PARK
Practice Address - State:IL
Practice Address - Zip Code:60805-2409
Practice Address - Country:US
Practice Address - Phone:708-422-1363
Practice Address - Fax:708-422-1256
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-23
Last Update Date:2016-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036098660207R00000X
IL207RE0101X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036093254Medicaid
IL036098660Medicaid
IL036086922Medicaid
IL036110790Medicaid