MEDICARE: KENT KAMRADT M.D.

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	207Q00000X	Family Medicine Physician	036078119	IL

General Provider Information

NPI Number	:	1598768939
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENT KAMRADT M.D.

Provider Business Mailing Address
First Line	:	480 S US HIGHWAY 45
Second Line	:	ABBVIE
City	:	GRAYSLAKE
State	:	IL
Zip	:	60030-3910
Country	:	US
Telephone Number	:	847-935-4421
Fax Number	:	847-935-4402

Provider Business Practice Location Address
First Line	:	480 S US HIGHWAY 45
Second Line	:	ABBVIE
City	:	GRAYSLAKE
State	:	IL
Zip	:	60030-3910
Country	:	US
Telephone Number	:	847-935-4421
Fax Number	:	847-935-4402

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

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	09/03/2015

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