Provider Demographics
NPI:1578797551
Name:FELISMENO G KINTANAR, MD
Entity Type:Organization
Organization Name:FELISMENO G KINTANAR, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FELISMENO
Authorized Official - Middle Name:G
Authorized Official - Last Name:KINTANAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-254-6611
Mailing Address - Street 1:1952 W CERMAK RD
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60608-4204
Mailing Address - Country:US
Mailing Address - Phone:773-254-6611
Mailing Address - Fax:773-254-8590
Practice Address - Street 1:1952 W CERMAK RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60608-4204
Practice Address - Country:US
Practice Address - Phone:773-254-6611
Practice Address - Fax:773-254-8590
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-06
Last Update Date:2009-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036046196207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036046196Medicaid