Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RN0300X | Nephrologist | 036-101210 | IL |
NPI | 1043269210 |
---|---|
Provider Name | Ajit Kumar Kesani |
First Address | Evanston, IL 60202-3439 |
Second Address | Evanston, IL 60202-3439 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2006 |
Last Update Date | 03/10/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036-101210 | MEDICAL LICENSE (01) | IL |
H40408 | (02) |