Provider Demographics
NPI:1588059786
Name:BAKHOS, FADI
Entity type:Individual
Prefix:
First Name:FADI
Middle Name:
Last Name:BAKHOS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 CENTER DR
Mailing Address - Street 2:
Mailing Address - City:VERNON HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60061-1584
Mailing Address - Country:US
Mailing Address - Phone:847-367-8764
Mailing Address - Fax:866-367-8319
Practice Address - Street 1:230 CENTER DR STE 101
Practice Address - Street 2:
Practice Address - City:VERNON HILLS
Practice Address - State:IL
Practice Address - Zip Code:60061-1584
Practice Address - Country:US
Practice Address - Phone:847-367-8815
Practice Address - Fax:866-367-8319
Is Sole Proprietor?:No
Enumeration Date:2015-04-03
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1443652086S0122X
IL036164179208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery