Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 036-148573 | IL |
N | 208600000X | Surgeon | 036-148573 | IL |
Y | 2086S0102X | Surgical Critical Care | 036-148573 | IL |
NPI | 1003047267 |
---|---|
Provider Name | Raelene D Kennedy |
First Address | Chicago, IL 60612-3863 |
Second Address | Chicago, IL 60612 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2009 |
Last Update Date | 30/08/2019 |