Basic Information
| Provider Information | |||||||||
| NPI: | 1699271445 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FALANEH | ||||||||
| FirstName: | KHWAILA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5904 W 88TH PL | ||||||||
| Address2: | |||||||||
| City: | OAK LAWN | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604531105 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 4901 W 79TH ST FL 2 | ||||||||
| Address2: | |||||||||
| City: | BURBANK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604591569 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3126090300 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/02/2018 | ||||||||
| LastUpdateDate: | 04/20/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/20/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 036-153621 | IL | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.