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General NPI Number Information
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NPI Number | 1508977513
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Entity Type | Organization
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Legal Business Name | KANKAKEE FAMILY MEDICINE
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 400 NORTH WALL ST STE 504
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City | KANKAKEE
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State | IL
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Zip | 60901-2965
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Country | US
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Telephone | 815-932-4021
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Fax | 815-932-7270
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Provider Business Mailing Address
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Address Line | 400 NORTH WALL ST STE 504
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City | KANKAKEE
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State | IL
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Zip | 60901-2965
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Country | US
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Telephone | 815-932-4021
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Fax | 815-932-7270
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Authorized Official
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Title or Position | PARTNER
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Name | DR. KENNETH GEORGE HANDY
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Credential | MD
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Telephone | 815-932-4021
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State | IL
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