Healthcare Provider Details

I. General information

NPI: 1891861969
Provider Name (Legal Business Name): KERI KWARTA AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1750 W HARRISON ST 203 SENN
CHICAGO IL
60612-3825
US

IV. Provider business mailing address

470 W MAHOGANY CT #405
PALATINE IL
60067-4998
US

V. Phone/Fax

Practice location:
  • Phone: 312-942-5332
  • Fax: 312-942-7068
Mailing address:
  • Phone: 847-963-0877
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: