Provider Demographics
NPI:1710127576
Name:KANTAR, MOUHANNAD (MD)
Entity Type:Individual
Prefix:DR
First Name:MOUHANNAD
Middle Name:
Last Name:KANTAR
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 1:345 E WACKER DR UNIT 4101
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60601-5274
Mailing Address - Country:US
Mailing Address - Phone:702-308-6892
Mailing Address - Fax:
Practice Address - Street 1:1051 ESSINGTON RD STE 290
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-2842
Practice Address - Country:US
Practice Address - Phone:815-773-7827
Practice Address - Fax:815-254-8442
Is Sole Proprietor?:No
Enumeration Date:2009-03-05
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036129917207QG0300X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine