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General NPI Number Information
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NPI Number | 1528397197
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Entity Type | Organization
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Legal Business Name | KND DEVELOPMENT 59 LLC
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Dates
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Enumeration Date | 12/10/2009
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Last Update Date | 02/10/2021
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Provider Practice Location Address
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Address Line | 225 EDWARD ST
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City | SYCAMORE
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State | IL
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Zip | 60178-2137
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Country | US
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Telephone | 815-895-2144
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Fax | 833-501-9731
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Provider Business Mailing Address
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Address Line | 680 S 4TH ST
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City | LOUISVILLE
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State | KY
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Zip | 40202-2407
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Country | US
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Telephone | 502-596-7358
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Fax | 833-501-9731
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Authorized Official
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Title or Position | DVP REVENUE CYCLE
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Name | LINDA L FISHER
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Credential |
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Telephone | 502-596-7358
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number |
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License Number State |
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