Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | 4301079546 | MI |
Y | 207PE0004X | Emergency Medical Services | 4301079546 | MI |
NPI | 1033192059 |
---|---|
Provider Name | Philip O Kilanowski-Doroh |
First Address | Palatine, IL 60055-0001 |
Second Address | Grand Blanc, MI 48439-8065 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/11/2005 |
Last Update Date | 06/03/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4733868 | (05) | MI |
4733877 | (05) | MI |
4733886 | (05) | MI |
I30662 | (02) | |
P00259481 | RAILROAD MEDICARE (01) | |
PK079546 | BLUE CROSS BLUE SHIELD (01) |