Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | IL |
NPI | 1538169834 |
---|---|
Provider Name | Dr. Kevin L Ziffra |
First Address | Park Ridge, IL 60068-1186 |
Second Address | Park Ridge, IL 60068-1186 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2005 |
Last Update Date | 12/10/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
L83931 | (02) | IL |