Healthcare Provider Details

I. General information

NPI: 1134157142
Provider Name (Legal Business Name): KENNETH M LANGWORTHY RVT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 S DRYDEN PL
ARLINGTON HEIGHTS IL
60004-6369
US

IV. Provider business mailing address

1157 W WRIGHTWOOD AVE
CHICAGO IL
60614-1355
US

V. Phone/Fax

Practice location:
  • Phone: 847-577-5814
  • Fax: 847-577-5914
Mailing address:
  • Phone: 630-209-9161
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246XC2903X
TaxonomyVascular Specialist/Technologist Cardiovascular
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: