Provider Demographics
NPI:1265579551
Name:QANDEEL, MONTHER (MD)
Entity type:Individual
Prefix:
First Name:MONTHER
Middle Name:
Last Name:QANDEEL
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 1:5841 S MARYLAND AVE
Mailing Address - Street 2:RM. Q219, MC2026
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60637-1447
Mailing Address - Country:US
Mailing Address - Phone:773-834-9980
Mailing Address - Fax:773-702-1161
Practice Address - Street 1:5841 S MARYLAND AVE
Practice Address - Street 2:RM. Q219, MC2026
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60637-1447
Practice Address - Country:US
Practice Address - Phone:773-834-9980
Practice Address - Fax:773-702-1161
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2016-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COTL-2167390200000X
CODR.00513382085R0202X
IL0361379322085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program