Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | 036-064666 | IL |
N | 207RP1001X | Pulmonary Disease | 036-064666 | IL |
N | 208000000X | Pediatrician | 036-064666 | IL |
NPI | 1437249760 |
---|---|
Provider Name | Kenneth Arnett |
First Address | Peoria, IL 61603-3089 |
Second Address | Peoria, IL 61603-3089 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/10/2006 |
Last Update Date | 10/01/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036064666 | (05) | IL |
H70513 | (02) |