Provider Demographics
NPI:1720543838
Name:AKHTAR, KAMAL (FNP)
Entity Type:Individual
Prefix:
First Name:KAMAL
Middle Name:
Last Name:AKHTAR
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4711 GOLF RD
Mailing Address - Street 2:STE 1250
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-1232
Mailing Address - Country:US
Mailing Address - Phone:847-235-6130
Mailing Address - Fax:847-941-0577
Practice Address - Street 1:300 HEALTH WAY DR
Practice Address - Street 2:
Practice Address - City:POTOSI
Practice Address - State:MO
Practice Address - Zip Code:63664-1420
Practice Address - Country:US
Practice Address - Phone:573-438-5451
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-02
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019003452363L00000X
IL277001620363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner