Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 36097782 | IL |
Y | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | 036.097782 | IL |
NPI | 1629042759 |
---|---|
Provider Name | Kimberly Kenton |
First Address | Chicago, IL 60611 |
Second Address | Chicago, IL 60611 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/02/2006 |
Last Update Date | 17/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H63160 | (02) |