Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RA0201X | Internist - Allergy & Immunology | 036095603 | IL |
NPI | 1538261151 |
---|---|
Provider Name | Dr. Kimberly Kay Ricaurte |
First Address | Winnetka, IL 60093-2355 |
Second Address | Winnetka, IL 60093-2355 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/09/2006 |
Last Update Date | 05/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036095603 | (05) | IL |
H01991 | (02) | IL |