Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223G0001X | General Practice | IL | |
N | 213EG0000X | General Practice | IL | |
N | 1223P0700X | Prosthodontist | IL |
NPI | 1013120203 |
---|---|
Provider Name | Kenneth Gehrke |
First Address | Chicago, IL 60612-7210 |
Second Address | Chicago, IL 60612-7210 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/05/2007 |
Last Update Date | 08/07/2007 |