Basic Information
| Provider Information | |||||||||
| NPI: | 1326090994 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FAKHOURI | ||||||||
| FirstName: | ANTON | ||||||||
| MiddleName: | JIRIES | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10330 S ROBERTS RD | ||||||||
| Address2: | |||||||||
| City: | PALOS HILLS | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604651971 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7082377200 | ||||||||
| FaxNumber: | 7082377201 | ||||||||
| Practice Location | |||||||||
| Address1: | 10330 S ROBERTS RD | ||||||||
| Address2: | |||||||||
| City: | PALOS HILLS | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604651971 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7082377200 | ||||||||
| FaxNumber: | 7082377201 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/16/2006 | ||||||||
| LastUpdateDate: | 12/20/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/20/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207XS0106X | 036-084909 | IL | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Hand Surgery | 207X00000X | 036-084909 | IL | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | P00973095 | 01 | IL | RAILROAD MEDICARE PTAN | OTHER |