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General NPI Number Information
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NPI Number | 1548903248
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Entity Type | Individual
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Provider Name | KHALIL QATU DDS
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Gender | Male
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Dates
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Enumeration Date | 04/19/2022
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Last Update Date | 03/12/2024
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Provider Practice Location Address
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Address Line | 2156 N DAMEN AVE
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City | CHICAGO
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State | IL
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Zip | 60647-6481
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Country | US
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Telephone | 312-312-3759
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Fax |
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Provider Business Mailing Address
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Address Line | 235 W VAN BUREN ST UNIT 4407
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City | CHICAGO
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State | IL
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Zip | 60607-3946
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Country | US
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Telephone | 248-672-2061
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 019.033844
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License Number State | IL
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