Healthcare Provider Details

I. General information

NPI: 1326184862
Provider Name (Legal Business Name): KENNETH A VATZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 01/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1140 CHERRY ST
WINNETKA IL
60093-2115
US

IV. Provider business mailing address

1140 CHERRY ST
WINNETKA IL
60093-2115
US

V. Phone/Fax

Practice location:
  • Phone: 847-612-1547
  • Fax: 847-441-7311
Mailing address:
  • Phone: 847-612-1547
  • Fax: 847-441-7311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number036051900
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: