Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | 036044332 | IL |
NPI | 1538146758 |
---|---|
Provider Name | Dr. Paul M Kentor |
First Address | Buffalo Grove, IL 60089-1388 |
Second Address | Buffalo Grove, IL 60089-1388 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/12/2005 |
Last Update Date | 24/01/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
210357 | GROUP (01) | IL |
C39838 | (02) | IL |