Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | 125067635 | IL |
NPI | 1053793315 |
---|---|
Provider Name | Max Kahn |
First Address | Peoria, IL 61637-0001 |
Second Address | Peoria, IL 61637-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2015 |
Last Update Date | 23/06/2015 |