Provider Demographics
NPI:1093931164
Name:KAHAN, LAURA (MED)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:KAHAN
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5315 W PATTERSON AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60641-3347
Mailing Address - Country:US
Mailing Address - Phone:773-685-8008
Mailing Address - Fax:773-341-7433
Practice Address - Street 1:5315 W PATTERSON AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60641-3347
Practice Address - Country:US
Practice Address - Phone:773-685-8008
Practice Address - Fax:773-341-7433
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist