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General NPI Number Information
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NPI Number | 1578797551
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Entity Type | Organization
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Legal Business Name | FELISMENO G KINTANAR, MD
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Dates
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Enumeration Date | 05/06/2009
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Last Update Date | 05/06/2009
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Provider Practice Location Address
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Address Line | 1952 W CERMAK RD
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City | CHICAGO
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State | IL
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Zip | 60608-4204
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Country | US
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Telephone | 773-254-6611
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Fax | 773-254-8590
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Provider Business Mailing Address
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Address Line | 1952 W CERMAK RD
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City | CHICAGO
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State | IL
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Zip | 60608-4204
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Country | US
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Telephone | 773-254-6611
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Fax | 773-254-8590
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Authorized Official
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Title or Position | OWNER
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Name | FELISMENO G KINTANAR
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Credential | MD
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Telephone | 773-254-6611
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 036046196
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License Number State | IL
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