Individual
ANTOUN AL KHABBAZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1200 W STATE ST, ROCKFORD, IL 61102-2112
(815) 490-1600
(815) 490-1485
Mailing address
1200 W STATE ST, ROCKFORD, IL 61102-2112
(815) 490-1600
(815) 490-1485
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
036116757
IL
207V00000X
Obstetrics & Gynecology Physician
37213
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
036116757
ILLINOIS LICENSE
IL
01
—
336077827
ILLINOIS CONTROLLED SUB
IL
05
—
64054091
—
KY
Enumeration date
08/22/2005
Last updated
03/07/2023
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