Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RI0011X | Interventional Cardiology | IL |
NPI | 1003862467 |
---|---|
Provider Name | Peter Michael Kerwin |
First Address | Lombard, IL 60148-6153 |
Second Address | Downers Grove, IL 60515-1552 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/05/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E35537 | (02) |