MEDICARE: DR. KHALIL QATU DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	019.033844	IL

General Provider Information

NPI Number	:	1548903248
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KHALIL QATU DDS

Provider Business Mailing Address
First Line	:	235 W VAN BUREN ST UNIT 4407
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60607-3946
Country	:	US
Telephone Number	:	248-672-2061
Fax Number	:

Provider Business Practice Location Address
First Line	:	2156 N DAMEN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-6481
Country	:	US
Telephone Number	:	312-312-3759
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/19/2022
Last Update Date	:	03/12/2024

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