Healthcare Provider Details

I. General information

NPI: 1699819078
Provider Name (Legal Business Name): FELISMENO G. KINTANAR M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2875 W 19TH ST
CHICAGO IL
60623-3501
US

IV. Provider business mailing address

305 RIDGEMOOR CT
WILLOWBROOK IL
60527-5445
US

V. Phone/Fax

Practice location:
  • Phone: 773-484-4425
  • Fax:
Mailing address:
  • Phone: 630-920-9856
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: