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General NPI Number Information
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NPI Number | 1912146119
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Entity Type | Organization
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Legal Business Name | KBCLINIC
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Dates
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Enumeration Date | 02/11/2009
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Last Update Date | 02/11/2009
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Provider Practice Location Address
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Address Line | 5666 EAST STATE STREET AMBULATORY SURGERY CENTER/ DR BLUMOFE
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City | ROCKFORD
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State | IL
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Zip | 61108-2425
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Country | US
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Telephone | 815-227-2274
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Fax |
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Provider Business Mailing Address
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Address Line | 6838 N KILPATRICK AVE
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City | LINCOLNWOOD
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State | IL
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Zip | 60712-2437
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Country | US
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Telephone | 847-763-9241
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Fax |
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Authorized Official
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Title or Position | GENERAL SURGEON
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Name | DR. KARIN ANNIKA BLUMOFE
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Credential | MD
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Telephone | 815-227-2274
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 036093795
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License Number State | IL
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