Provider Demographics
NPI:1134157142
Name:LANGWORTHY, KENNETH M (RVT)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:M
Last Name:LANGWORTHY
Suffix:
Gender:M
Credentials:RVT
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Other - Credentials:
Mailing Address - Street 1:1157 W WRIGHTWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-1355
Mailing Address - Country:US
Mailing Address - Phone:630-209-9161
Mailing Address - Fax:
Practice Address - Street 1:15 S DRYDEN PL
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60004-6369
Practice Address - Country:US
Practice Address - Phone:847-577-5814
Practice Address - Fax:847-577-5914
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2007-07-08
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246XC2903XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularVascular Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0002232513OtherBLUECROSSBLUESHIELD OF IL
IL210986Medicare ID - Type Unspecified