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General NPI Number Information
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NPI Number | 1104073576
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Entity Type | Organization
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Legal Business Name | IPA OF KANE COUNTY
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Dates
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Enumeration Date | 08/27/2008
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Last Update Date | 10/26/2013
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Provider Practice Location Address
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Address Line | 8529 W. 191ST STREET
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City | MOKENA
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State | IL
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Zip | 60448
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Country | US
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Telephone | 877-226-3676
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Fax | 877-226-3811
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Provider Business Mailing Address
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Address Line | P.O. BOX 728
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City | FRANKFORT
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State | IL
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Zip | 60423
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Country | US
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Telephone | 877-226-3676
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Fax | 877-226-3811
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. KEVIN N. HNATUSKO
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Credential |
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Telephone | 877-226-3676
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number |
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License Number State |
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