Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | IL |
NPI | 1003800129 |
---|---|
Provider Name | Mrs. Karin Kallwitz |
First Address | Grayslake, IL 60030-2061 |
Second Address | Grayslake, IL 60030-2061 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/09/2005 |
Last Update Date | 08/07/2007 |