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General NPI Number Information
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NPI Number | 1427598432
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Entity Type | Organization
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Legal Business Name | ANTHONY W. KITSLAAR, M.D.
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Dates
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Enumeration Date | 02/24/2017
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Last Update Date | 02/24/2017
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Provider Practice Location Address
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Address Line | 1250 EXECUTIVE PL SUITE 403
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City | GENEVA
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State | IL
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Zip | 60134-3807
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Country | US
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Telephone | 630-302-3336
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Fax |
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Provider Business Mailing Address
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Address Line | 1250 EXECUTIVE PL SUITE 403
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City | GENEVA
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State | IL
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Zip | 60134-3807
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Country | US
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Telephone | 630-302-3336
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Fax |
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Authorized Official
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Title or Position | SOLE PROPRIETOR
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Name | ANTHONY KITSLAAR
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Credential | M.D.
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Telephone | 630-302-3336
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QX0100X
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Taxonomy Name | Occupational Medicine Clinic/Center
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License Number | 036.072436
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License Number State | IL
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