Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RP1001X | Pulmonary Disease | 036063207 | IL |
NPI | 1053337758 |
---|---|
Provider Name | Dr. Richard D. Kern |
First Address | Evergreen Park, IL 60805-2701 |
Second Address | Evergreen Park, IL 60805-2701 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2006 |
Last Update Date | 12/04/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036-063207 | (05) | IL |
C41656 | (02) |