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General NPI Number Information
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NPI Number | 1275655151
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Entity Type | Organization
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Legal Business Name | PAUL M KENTOR MD SC
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Dates
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Enumeration Date | 04/04/2007
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Last Update Date | 10/13/2023
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Provider Practice Location Address
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Address Line | 580 ROGER WILLIAMS AVE STE 25
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City | HIGHLAND PARK
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State | IL
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Zip | 60035-4820
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Country | US
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Telephone | 847-634-1690
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Fax | 847-634-1841
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Provider Business Mailing Address
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Address Line | 580 ROGER WILLIAMS AVE STE 25
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City | HIGHLAND PARK
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State | IL
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Zip | 60035-4820
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Country | US
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Telephone | 847-634-1690
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Fax | 847-634-1841
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. PAUL M KENTOR
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Credential | MD
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Telephone | 847-634-1690
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207K00000X
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Taxonomy Name | Allergy & Immunology Physician
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License Number | 036044332
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License Number State | IL
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