Provider Demographics
NPI:1548903248
Name:QATU, KHALIL (DDS)
Entity type:Individual
Prefix:DR
First Name:KHALIL
Middle Name:
Last Name:QATU
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 W VAN BUREN ST UNIT 4407
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-3946
Mailing Address - Country:US
Mailing Address - Phone:248-672-2061
Mailing Address - Fax:
Practice Address - Street 1:2156 N DAMEN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-6481
Practice Address - Country:US
Practice Address - Phone:312-312-3759
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-19
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0338441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice