Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | IL |
NPI | 1063477438 |
---|---|
Provider Name | Dr. Brian Kern |
First Address | Chicago, IL 60694-9000 |
Second Address | Hinsdale, IL 60521-3829 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/04/2006 |
Last Update Date | 25/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C44799 | (02) | IL |