Provider Demographics
NPI:1457327173
Name:OBARSKI, KENNETH S (DPM)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:S
Last Name:OBARSKI
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10580 OLCOTT AVE
Mailing Address - Street 2:
Mailing Address - City:ST JOHN
Mailing Address - State:IN
Mailing Address - Zip Code:46373-8942
Mailing Address - Country:US
Mailing Address - Phone:219-558-8540
Mailing Address - Fax:219-627-4040
Practice Address - Street 1:425 HUEHL RD
Practice Address - Street 2:UNIT 13
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-2322
Practice Address - Country:US
Practice Address - Phone:847-504-5000
Practice Address - Fax:847-504-5015
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2014-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016-003964213EP1101X
IN07000623A213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL016003964Medicaid
IL6000164646OtherBLUE CROSS/BLUE SHIELD
IL110025242OtherRAILROAD MEDICARE
IN200224560AMedicaid
IL110025242OtherRAILROAD MEDICARE
IN200224560AMedicaid
ILL67126Medicare PIN
ILT38654Medicare UPIN
IL6000164646OtherBLUE CROSS/BLUE SHIELD
IN859800IMedicare PIN
IN859800IMedicare PIN
ILL74887Medicare PIN