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General NPI Number Information
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NPI Number | 1366421422
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Entity Type | Individual
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Provider Name | KENNETH W SAPP D.O.
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Gender | Male
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Dates
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Enumeration Date | 01/16/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3001A SIXTH STREET LABORATORY, NAVAL HEALTH CLINIC GREAT LAKES
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City | GREAT LAKES
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State | IL
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Zip | 60088
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Country | US
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Telephone | 847-688-6850
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Fax |
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Provider Business Mailing Address
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Address Line | 325 EAST BLODGETT AVENUE
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City | LAKE BLUFF
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State | IL
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Zip | 60044-2112
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Country | US
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Telephone | 847-482-1938
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Fax |
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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 | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number | 0102037035
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License Number State | VA
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