Healthcare Provider Details

I. General information

NPI: 1821381062
Provider Name (Legal Business Name): GEORGE A. KANNANKERIL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2011
Last Update Date: 03/24/2021
Certification Date: 03/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9650 GROSS POINT RD STE 2900
SKOKIE IL
60076-1214
US

IV. Provider business mailing address

9650 GROSS POINT RD STE 2900
SKOKIE IL
60076-1214
US

V. Phone/Fax

Practice location:
  • Phone: 847-503-4500
  • Fax: 847-657-5754
Mailing address:
  • Phone: 847-503-4500
  • Fax: 847-657-5754

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number036.137826
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: