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General NPI Number Information
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NPI Number | 1326136037
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Entity Type | Individual
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Provider Name | JEFFREY RONALD KANOFSKY M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/10/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | HINES VA HOSPITAL FIFTH AVENUE & ROOSEVELT ROAD
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City | HINES
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State | IL
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Zip | 60141
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Country | US
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Telephone | 708-202-8387
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Fax | 708-202-8387
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Provider Business Mailing Address
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Address Line | 261 E ADELIA ST
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City | ELMHURST
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State | IL
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Zip | 60126-3537
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Country | US
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Telephone | 708-202-8387
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Fax | 708-202-8387
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number |
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License Number State | IL
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