Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 036-084909 | IL |
N | 207XS0106X | Orthopaedic Hand Surgeon | 036-084909 | IL |
NPI | 1326090994 |
---|---|
Provider Name | Dr. Anton Jiries Fakhouri |
First Address | Palos Hills, IL 60465-1971 |
Second Address | Palos Hills, IL 60465-1971 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2006 |
Last Update Date | 20/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E95944 | (02) | IL |
P00973095 | RAILROAD MEDICARE PTAN (01) | IL |