Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | 036091917 | IL |
NPI | 1023007887 |
---|---|
Provider Name | Dr. William H Kobak |
First Address | St Charles, IL 60174-0657 |
Second Address | St Charles, IL 60175-1000 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/10/2005 |
Last Update Date | 01/08/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036091917 | (05) | IL |
F83839 | (02) | IL |