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General NPI Number Information
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NPI Number | 1457327173
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Entity Type | Individual
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Provider Name | KENNETH S OBARSKI DPM
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Gender | Male
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Dates
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Enumeration Date | 02/23/2006
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Last Update Date | 05/12/2014
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Provider Practice Location Address
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Address Line | 425 HUEHL RD UNIT 13
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City | NORTHBROOK
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State | IL
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Zip | 60062-2322
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Country | US
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Telephone | 847-504-5000
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Fax | 847-504-5015
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Provider Business Mailing Address
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Address Line | 10580 OLCOTT AVE
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City | ST JOHN
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State | IN
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Zip | 46373-8942
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Country | US
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Telephone | 219-558-8540
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Fax | 219-627-4040
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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 | 213EP1101X
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Taxonomy Name | Primary Podiatric Medicine Podiatrist
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License Number | 016-003964
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 213EP1101X
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Taxonomy Name | Primary Podiatric Medicine Podiatrist
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License Number | 07000623A
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License Number State | IN
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