Healthcare Provider Details

I. General information

NPI: 1104073576
Provider Name (Legal Business Name): IPA OF KANE COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2008
Last Update Date: 10/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8529 W. 191ST STREET
MOKENA IL
60448
US

IV. Provider business mailing address

P.O. BOX 728
FRANKFORT IL
60423
US

V. Phone/Fax

Practice location:
  • Phone: 877-226-3676
  • Fax: 877-226-3811
Mailing address:
  • Phone: 877-226-3676
  • Fax: 877-226-3811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number State

VIII. Authorized Official

Name: MR. KEVIN N. HNATUSKO
Title or Position: ADMINISTRATOR
Credential:
Phone: 877-226-3676