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General NPI Number Information
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NPI Number | 1134623820
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Entity Type | Individual
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Provider Name | ANTOINE AZAR MD
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Gender | Male
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Dates
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Enumeration Date | 03/19/2018
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Last Update Date | 06/28/2024
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Provider Practice Location Address
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Address Line | 4440 W 95TH ST
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City | OAK LAWN
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State | IL
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Zip | 60453-2600
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Country | US
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Telephone | 708-684-6949
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Fax |
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Provider Business Mailing Address
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Address Line | 1620 W HARRISON ST
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City | CHICAGO
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State | IL
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Zip | 60612-3801
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Country | US
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Telephone | 312-942-5000
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 036.165123
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | ME141700
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number | 036.165123
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License Number State | IL
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