Provider Demographics
NPI:1275655151
Name:PAUL M KENTOR MD SC
Entity Type:Organization
Organization Name:PAUL M KENTOR MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:M
Authorized Official - Last Name:KENTOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-634-1690
Mailing Address - Street 1:580 ROGER WILLIAMS AVE STE 25
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035-4820
Mailing Address - Country:US
Mailing Address - Phone:847-634-1690
Mailing Address - Fax:847-634-1841
Practice Address - Street 1:580 ROGER WILLIAMS AVE STE 25
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60035-4820
Practice Address - Country:US
Practice Address - Phone:847-634-1690
Practice Address - Fax:847-634-1841
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036044332207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK12415OtherMCR IND PTAN
ILDG7085OtherRR MCR PTAN
ILIL8708OtherMCR GROUP PTAN
IL210357OtherGROUP
IL210357OtherGROUP