Healthcare Provider Details

I. General information

NPI: 1851461289
Provider Name (Legal Business Name): KENNETH ALLEN KUZNETSKY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5645 W ADDISON ST
CHICAGO IL
60634-4403
US

IV. Provider business mailing address

2253 N GENEVA TER
CHICAGO IL
60614-3746
US

V. Phone/Fax

Practice location:
  • Phone: 773-348-4640
  • Fax: 773-794-4698
Mailing address:
  • Phone: 773-348-4640
  • Fax: 773-794-4698

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: