| Doctor Name: | MR. SARGISS KHOSHABA |
| NPI Number: | 1457546129 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | |
| Business Practice Address: | 1627 W Belmont Ave Chicago, IL - 606573017 |
| Business Phone Number: | 7734771069 |
| Business Fax Number: | 7734773462 |
| Mailing Address: | 1627 W Belmont Ave, CHICAGO |
| State: | IL |
| Postal Code: | 606573017 |
| Phone Number: | 7734771069 |
| Fax Number: | 7734773462 |
| NPI Enumeration Date: | 09/06/2007 |
| NPI Last Update Date: | 09/06/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 251G00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | IL |
| Taxonomy Type: | Agencies |
| Taxonomy Classification: | Hospice Care, Community Based |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |