Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 036127108 | IL |
Y | 2080P0203X | Pediatric Critical Care Doctor | 036127108 | IL |
NPI | 1083919864 |
---|---|
Provider Name | Dr. Ronald Kampanatkosol |
First Address | Oak Lawn, IL 60453-2600 |
Second Address | Oak Lawn, IL 60453-2600 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/01/2011 |
Last Update Date | 04/01/2015 |