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General NPI Number Information
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NPI Number | 1376751982
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Entity Type | Organization
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Legal Business Name | WALID N. GHANTOUS MD LTD
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Dates
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Enumeration Date | 05/18/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1445 N HUNT CLUB RD SUITE 201
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City | GURNEE
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State | IL
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Zip | 60031-2603
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Country | US
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Telephone | 847-855-9152
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Fax | 847-855-5215
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Provider Business Mailing Address
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Address Line | PO BOX 557
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City | WILMETTE
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State | IL
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Zip | 60091-0557
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Country | US
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Telephone | 847-446-3200
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Fax | 847-855-5215
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | DR. WALID GHANTOUS
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Credential | M.D.
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Telephone | 847-855-9152
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State | IL
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