Healthcare Provider Details

I. General information

NPI: 1528334208
Provider Name (Legal Business Name): KAY CHOW TIMBERS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2012
Last Update Date: 03/29/2021
Certification Date: 03/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 N WALL ST STE B410
KANKAKEE IL
60901-2940
US

IV. Provider business mailing address

400 N WALL ST STE B410
KANKAKEE IL
60901-2940
US

V. Phone/Fax

Practice location:
  • Phone: 815-933-2221
  • Fax: 815-933-3975
Mailing address:
  • Phone: 815-933-2221
  • Fax: 815-933-3975

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number036-143927
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: