Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 125.058298 | IL |
NPI | 1053622928 |
---|---|
Provider Name | Dr. Akta Kakodkar |
First Address | Bourbonnais, IL 60914-5070 |
Second Address | Bourbonnais, IL 60914-5070 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/06/2010 |
Last Update Date | 13/08/2015 |