Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 019019106 | IL |
NPI | 1003040155 |
---|---|
Provider Name | Michael Kazmer |
First Address | Franklin Park, IL 60131-2068 |
Second Address | Franklin Park, IL 60131-2068 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/05/2009 |
Last Update Date | 05/05/2009 |