Provider Demographics
NPI:1194781112
Name:ISKANDER, SAFWAT G (MD)
Entity type:Individual
Prefix:
First Name:SAFWAT
Middle Name:G
Last Name:ISKANDER
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 1:400 N WALL ST
Mailing Address - Street 2:SUITE 312
Mailing Address - City:KANKAKEE
Mailing Address - State:IL
Mailing Address - Zip Code:60901-2940
Mailing Address - Country:US
Mailing Address - Phone:815-933-3200
Mailing Address - Fax:815-933-3557
Practice Address - Street 1:400 N WALL ST
Practice Address - Street 2:SUITE 312
Practice Address - City:KANKAKEE
Practice Address - State:IL
Practice Address - Zip Code:60901-2940
Practice Address - Country:US
Practice Address - Phone:815-933-3200
Practice Address - Fax:815-933-3557
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-26
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036102421208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036102421Medicaid