Healthcare Provider Details

I. General information

NPI: 1326338971
Provider Name (Legal Business Name): KIRBY ADLAM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2011
Last Update Date: 04/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1740 W TAYLOR ST
CHICAGO IL
60612-7232
US

IV. Provider business mailing address

8658 HAMLIN AVE
SKOKIE IL
60076-2210
US

V. Phone/Fax

Practice location:
  • Phone: 866-600-2273
  • Fax:
Mailing address:
  • Phone: 773-387-2900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number209008714
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: