Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Fazl Khademi

Individual provider Student in an Organized Health Care Education/Training Program · NPI 1740992577

Fazl Khademi is a Student in an Organized Health Care Education/Training Program in Peoria, Illinois. Practices as a sole proprietor. Registered with an NPI since 2022.

In the registry since
2022

Practice location Address checks out

530 NE Glen Oak Ave
Peoria, IL 61637-0001
Phone: (309) 655-2000
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Student in an Organized Health Care Education/Training Program (primary) Taxonomy 390200000X

Record details

NPI number1740992577
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorYes
NPI enumeratedDecember 23, 2022
Last updated in NPPESMarch 30, 2023
Certification dateMarch 30, 2023
Mailing address5817 W Cherry Ct, Visalia, CA 93277-8873

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