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General NPI Number Information
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NPI Number | 1932480605
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Entity Type | Organization
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Legal Business Name | KISHWAUKEE PHYSICIAN GROUP INC
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Dates
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Enumeration Date | 09/07/2011
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Last Update Date | 04/16/2018
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Provider Practice Location Address
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Address Line | 1 KISH HOSPITAL DR
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City | DEKALB
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State | IL
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Zip | 60115-9602
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Country | US
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Telephone | 815-756-1521
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 487
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City | DEKALB
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State | IL
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Zip | 60115-0487
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Country | US
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Telephone | 815-756-1521
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF FINANCE
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Name | MS. CHRISTINE ZYDEK
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Credential |
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Telephone | 815-748-2986
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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 |
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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