Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 021-000882 | IL |
NPI | 1013190933 |
---|---|
Provider Name | Dr. Herbert M Kanter |
First Address | Arlington Heights, IL 60004-1582 |
Second Address | Arlington Heights, IL 60004-1582 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/12/2007 |
Last Update Date | 13/12/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
363011151 | (02) | IL |
80005430 | BLUECROSS BLUESHIELD (01) | IL |