Provider Demographics
NPI:1972528321
Name:ARMBRUSTER, KENT F (MD)
Entity Type:Individual
Prefix:
First Name:KENT
Middle Name:F
Last Name:ARMBRUSTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 W 95TH ST
Mailing Address - Street 2:BUSINESS DEVELOPMENT, 3N
Mailing Address - City:EVERGREEN PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60805-2701
Mailing Address - Country:US
Mailing Address - Phone:708-229-5420
Mailing Address - Fax:708-229-4209
Practice Address - Street 1:9800 SOUTHWEST HWY
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-3617
Practice Address - Country:US
Practice Address - Phone:708-229-6985
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2016-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036041145207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036041145Medicaid
390004080Medicare PIN
IL036041145Medicaid
ILF400255336Medicare PIN
IL634050Medicare PIN