MEDICARE: KENNETH EDWARD KORBER P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	0085-000497	IL

General Provider Information

NPI Number	:	1174655948
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNETH EDWARD KORBER P.A.

Provider Business Mailing Address
First Line	:	1522 E PEACHTREE DR
Second Line	:
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60004-3422
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1522 E PEACHTREE DR
Second Line	:
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60004-3422
Country	:	US
Telephone Number	:	847-804-7700
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/09/2007
Last Update Date	:	07/08/2007

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