Provider Demographics
NPI:1326090994
Name:FAKHOURI, ANTON JIRIES (MD)
Entity Type:Individual
Prefix:DR
First Name:ANTON
Middle Name:JIRIES
Last Name:FAKHOURI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10330 S ROBERTS RD
Mailing Address - Street 2:
Mailing Address - City:PALOS HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60465-1971
Mailing Address - Country:US
Mailing Address - Phone:708-237-7200
Mailing Address - Fax:708-237-7201
Practice Address - Street 1:10330 S ROBERTS RD
Practice Address - Street 2:
Practice Address - City:PALOS HILLS
Practice Address - State:IL
Practice Address - Zip Code:60465-1971
Practice Address - Country:US
Practice Address - Phone:708-237-7200
Practice Address - Fax:708-237-7201
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-084909207XS0106X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00973095OtherRAILROAD MEDICARE PTAN
ILIL5520002Medicare PIN
ILE95944Medicare UPIN
ILIL5519002Medicare PIN
ILP00973095OtherRAILROAD MEDICARE PTAN