Healthcare Provider Details

I. General information

NPI: 1982449369
Provider Name (Legal Business Name): FARES ANTAKI MD, FRCSC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2024
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CHUM 1000 RUE SAINT-DENIS
MONTREAL QUEBEC
H2X 0C1
CA

IV. Provider business mailing address

CHUM 1000 RUE SAINT-DENIS
MONTREAL QUEBEC
H2X 0C1
CA

V. Phone/Fax

Practice location:
  • Phone:
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number35.150335
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number35.150335
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: