Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 036132891 | IL |
NPI | 1013176684 |
---|---|
Provider Name | Matthew Lowell Kircher |
First Address | Chicago, IL 60608-2241 |
Second Address | Maywood, IL 60153-3328 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2008 |
Last Update Date | 29/04/2021 |