Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1100X | Ophthalmic | 180180 | IL |
NPI | 1538799895 |
---|---|
Provider Name | Kortney Kathleen Marszalek |
First Address | New Lenox, IL 60451-6046 |
Second Address | Frankfort, IL 60423-1866 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/01/2020 |
Last Update Date | 24/01/2020 |