Provider Demographics
NPI:1811055742
Name:HARRIS, KENNETH PAUL (RESPIRATORY THERAPIS)
Entity type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:PAUL
Last Name:HARRIS
Suffix:
Gender:M
Credentials:RESPIRATORY THERAPIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:534 BROCKTON LN
Mailing Address - Street 2:
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60193-2402
Mailing Address - Country:US
Mailing Address - Phone:847-891-2033
Mailing Address - Fax:847-891-1268
Practice Address - Street 1:534 BROCKTON LN
Practice Address - Street 2:
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60193-2402
Practice Address - Country:US
Practice Address - Phone:847-891-2033
Practice Address - Fax:847-891-1268
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Certified
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1256950001Medicare NSC